Ringkasan Kasus

Laki-laki 57 tahun
Nyeri dada sejak 2 hari SMRS seperti dihimpit saat
istirahat, disertai keringat dingin, berlangsung > 20
menit

FR : merokok
TD : 120/70, nadi 70x/menit, nafas 18x/menit,
PF : dbn
Lab : Trop T 0,41 ng/mL

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 Apa diagnosis pasien ini?

Bagaimana stratifikasi risiko pasien ini?
Bagaimana rencana manajemen selanjutnya
pasien ini?

UA/NSTEMI- conservative strategy

Class
1

No subsequent features that necessitates CAG

EF<40
%

LV EF

EF>40
%

Stress testing
High Risk

CAG

Low risk
ASA indefinitely
Clopidogrel 1 month (ideally up to 1
year)
Discontinue IV GPIIb/IIIa inhibitor if
started previously
Continue UFH for 48 hrs or
administer enoxaparin or
fondaparinux max up to 8days
orduration of hospitalization
11

UA/NSTEMI- Conservative Strategy

Class IIa

Recurrent ischemic discomfort with ASA+

Clopidogrel+Anticoagulant treatment

Add a GPIIb/IIIa inhibitor before diagnostic CAG

Omit GPIIB/IIIa inhibitors if bivalirudin is selected as the

anticoagulant & 300-600 mg clopidogrel was
administered 6 hours earlier than planned CAG or PCI

12

Management after Diagnostic

Angiography in Patients with UA/NSTEMI
Dx Angiography
Select Post Angiography Management
Strategy

CABG

Cont ASA .
DC clopidogrel 5 to 7 d prior to
elective CABG.

DC IV GP IIb/IIIa 4 h prior to CABG

Cont UFH
DC enoxaparin 12 to 24 h prior to
CABG;

DC fondaparinux 24 h prior to
CABG;

DC bivalirudin 3 h prior to CABG. Dose

with UFH per institutional practice

PCI

Cont ASA
LD of clopidogrel if

not given pre angio

&
IV GP IIb/IIIa if not
started pre angio

DC ACT after PCI for

uncomplicated cases

Medical therapy
No
significant
obstructiv
e CAD on
angiograp
hy
Antiplatel
et
and ACT
at
physician
s
discretio
n (Class
I, LOE: C)

CAD
CAD on
on angiography
angiography

Cont ASA
LD of clopidogrel if not
given pre angio

DC IV GP IIb/IIIa after

at least 12 h if started pre angio

Cont IV UFH for at least 48 h

or
enoxaparin or fondaparinux for dur of
hosp ;
either DC bivalirudin or cont at a dose
of 0.25 mg/kg/hr for up to 72 h at
physicians discretion .
13

TIMI RISK

Age
: 0
Known CAD
: 0
ASA
: 0
Severe angina
: 1
> 3 FR
: 0
Biomarker (+)
: 1
ST-T change
: 0

2/7

GRACE SCORE
Age 57
: 36
HR 90
: 13
SBP 120
: 37
Cr 0,9
: 8
Killip I
: 0
Elevated biomarker
ST Segmen deviation

: 15
: 0

109
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DIAGNOSIS
NSTEMI TIMI 2/7 Grace 109
Old MCI anteroseptal
Hipokalemia

TERAPI
O2 3-4L/, Tirah baring
IVFD RL 1 kolf/24jam
Aspilet 1x80mg tab
Clopidogrel 1x75mg tab
Fondaparinux 1x2,5 mg SK
ISDN 3x5 mg
Atorvastatin 1x40 mg
Ramipril 1x2.5 mg
Bisoprolol 1x2,5 mg
Ranitidin 2x50 mg IV
Alprazolam 1x0,5 mg
Laxadyn syr 1x10cc
KSR 3x1 tab

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