Download Journal meeting with EMB 急診室的如臨大敵STEMI 101.03.12 ER

Journal meeting with EMB
急診室的如臨大敵 STEMI
101.03.12
ER 陳莉瑋醫師
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Question 1
Is O2 need in every chest pain
patient?
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Revisiting the role of oxygen
therapy in cardiac patients.
Moradkhan R, Sinoway LI
J Am Coll Cardiol. 2010;56(13):1013.
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Chest pain->O2 to keep SpO2:100%
Really good?
hyperoxia reduced coronary blood flow (CBF) ,heart rate,
cardiac output/index and cardiac oxygen consumption
=> a rise in blood pressure, systemic vascular resistance
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Hyperoxia, which might occur with
the administration of oxygen to
normoxic individuals, has been
shown to have a direct
vasoconstrictor effect on the
coronary arteries
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The current guidelines of oxygen
therapy are not based on randomized,
double blinded and controlled
studies
We propose that such studies are
imperative to delineate the precise
role of oxygen therapy in these
conditions
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In conclusion…
We recommend supplemental oxygen to
patients with an arterial
saturation less than 90 percent,
patients in respiratory distress,
or those with other high-risk
features for hypoxia
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Question 2
What if UGIB bleeding happen in
treating ACS?
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Gastrointestinal Bleeding in
Patients With Acute Coronary
Syndromes:Incidence, Predictors,
and Clinical Implications
J Am Coll Cardiol 2009;
54:1293–302
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Objectives
GIB is a potential hemorrhagic
complication in patients with ACS
treated with antithrombotic and/or
antiplatelet medications.
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Methods
In the ACUITY (Acute Catheterization and
Urgent Intervention Triage Strategy)
trial, 13,819 patients with moderateand high-risk ACS, enrolled at 450
centers in 17 countries between August
2003 and December 2005, were randomized
to the open-label use of 1 of 3
antithrombin regimens (heparin plus a
glycoprotein IIb/IIIa inhibitor, bivalirudin plus a
glycoprotein IIb/IIIa inhibitor, or bivalirudin
monotherapy).
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Results
GIB within 30 days occurred in 178
patients (1.3%).
Older age, baseline anemia, longer
duration of study drug
administration before angiogram,
smoking, ST-segment deviation 1 mm,
and diabetes were identified as
independent predictors of GIB.
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 On multivariable analysis, GIB was
strongly associated with 30-day allcause mortality , cardiac mortality ,
and composite ischemia , as well as with
1-year all-cause mortality , cardiac
mortality , myocardial infarction , and
composite ischemia
 Patients who experienced GIB had
significantly higher rates of stent
thrombosis compared with patients
without GIB
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Conclusions
GIB is a serious condition in the
scenario of ACS and is
independently associated with
mortality and ischemic
complications.
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Upper gastrointestinal bleeding in patients receiving dual
antiplatelet therapy after coronary stenting.
Internal Medicine. 48(19):1725-30, 2009.
 Concomitant use of an anti-secretory
agent was associated with a reduced risk
of UGI bleeding.
 Use of PPI may be associated with an
attenuation of the effect of dual
antiplatelet therapy.
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Gastrointestinal Bleeding in Percutaneous Coronary Intervention
and Acute Coronary Syndromes
This is true with regard to the elderly,
women, and patients with lower weight,
impaired renal function, or baseline
anemia
Early endoscopy is beneficial and
indicated if GIB occurs in the setting
of ACS, despite a higher risk, that
occurs mostly in unstable patients.
Intravenous PPI administration, both
before and after endoscopy, can improve
clinical outcomes.
The American Journal of Cardiology Vol 104 (5A) September 7, 2009
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感謝聆聽
敬請指教
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