心血管急症(ASC).ppt

CME-accredited symposium jointly sponsored by the University of Massachusetts Medical School and CMEducation Resources, LLCCommercial Support: Sponsored by an independent educational grant from The Medicines CompanyMission statement: Improve patient care through evidence-based education, expert analysis, and case study-based managementProcesses: Strives for fair balance and clinical relevance; stresses on-label indications for agents discussed, and emerging evidence and information from recent studiesCOI: Full faculty disclosures provided in syllabus and at the beginning of the program Program Educational Objectives Changing the Calculation Assessing Adherence to Guidelines “We need to invert the current equation to calculate an opportunity score for ACS patients rather than a risk score. Patients with higher baseline risks, such as the elderly, would have higher opportunity scores for benefit, even allowing for some of the greater risks from the treatment.” Acute Coronary SyndromesClinical Spectrum and Presentation We Must Risk Stratify Patientswith Chest Pain Three levels of risk stratification are pertinent to Emergency Department Management Low, intermediate, or high risk that ischemic symptoms are a result of CAD Low, intermediate, or high risk of short-term death or nonfatal MI from ACS Dynamic, ongoing risk-oriented evaluation of low- or intermediate-risk patients for “conversion” to high-risk status that is linked to intensity of treatment “Dynamic Risk Stratification” Tools History and Physical Standard EKG and non-standard EKG leads 15-lead ECGs should, perhaps, be “standard” in all but very-low-risk patients Biomarkers CPK-MB, Troponins I and T, Myoglobin Ischemia-Modified Albumin Non-Invasive Imaging Echocardiogram Stress testing Technetium-99m-sestamibi Predictive Indices/Schemes Better as research tools than for real-time clinical decision-making “The Guidelines”Classes of Recommendations Intervention is useful and effective