PHÂN TẦNG NGUY CƠ VÀ CHIẾN LƯỢC ĐIỀU TRỊ TRONG HỘI CHỨNG VÀNH CẤP: KHI NÀO NÊN CAN THIỆP MẠCH VÀNH? GS TS BS Võ Thành Nhân ĐH Y Dược – BV Chợ Rẫy TP HCM Calculating GRACE Risk Score Killip class Points Systolic BP Points Age Points I ≤70 66 ≤30 0-0.39 II 17 70-89 53 30-49 10 III 34 90-109 40 50-69 IV 51 110-129 27 ≥130 19 Baseline risk factors Points Cardiac arrest at admission 38 ST-segment deviation 18 Positive cardiac markers 14 STEMI 14 Total from clinical evaluation Creatinine Points Heart rate Points ≤70 10 0.4-0.9 70-89 15 29 1.0-1.9 32 90-109 26 70-79 56 ≥2 51 110-129 32 80-89 73 130-149 24 ≥90 91 150-169 16 170-199 ≥200 2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes 2015 ESC Guidelines for the management of ACS without persistent ST-segment elevation European Heart Journal Advance Access published August 29, 2015 2015 ESC Guidelines for the management of ACS without persistent ST-segment elevation 2015 ESC Guidelines for the management of ACS without persistent ST-segment elevation 2015 ESC Guidelines for the management of ACS without persistent ST-segment elevation 2015 ESC Guidelines for the management of ACS without persistent ST-segment elevation 2015 ESC Guidelines for the management of ACS without persistent ST-segment elevation 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction Developed in Collaboration with American College of Emergency Physicians and Society for Cardiovascular Angiography and Interventions © American College of Cardiology Foundation and American Heart Association, Inc Primary PCI in STEMI Indications for Transfer for Angiography After Fibrinolytic Therapy *Although individual circumstances will vary, clinical stability is defined by the absence of low output, hypotension, persistent tachycardia, apparent shock, high-grade ventricular or symptomatic supraventricular tachyarrhythmias, and spontaneous recurrent ischemia Indications for PCI of an Infarct Artery in Patients Who Were Managed With Fibrinolytic Therapy or Who Did Not Receive Reperfusion Therapy *Although individual circumstances will vary, clinical stability is defined by the absence of low output, hypotension, persistent tachycardia, apparent shock, high-grade ventricular or symptomatic supraventricular tachyarrhythmias, and spontaneous recurrent ischemia PCI of a Noninfarct Artery Before Hospital Discharge I IIa IIb III PCI is indicated in a noninfarct artery at a time separate from primary PCI in patients who have spontaneous symptoms of myocardial ischemia I IIa IIb III PCI is reasonable in a noninfarct artery at a time separate from primary PCI in patients with intermediate- or high-risk findings on noninvasive testing Cám ơn ý quý vị