Yeo Hans Cahyadi Yeo Hans Cahyadi MD PhDMD PhD FESC FESC

Born: Jakarta, 24 August 1955Born: Jakarta, 24 August 1955Status: Married, 3 childrenStatus: Married, 3 childrenEducation: High school, Budi Mulia, 1973Education: High school, Budi Mulia, 1973

GP, University of Indonesia, 1980 GP, University of Indonesia, 1980 Cardiologist, Kanazawa Med University, Japan,1991 Cardiologist, Kanazawa Med University, Japan,1991 PhD, Kanazawa Medical University, Japan, 1991PhD, Kanazawa Medical University, Japan, 1991

Fellow of European Society of Cardiology (FESC), 2007Fellow of European Society of Cardiology (FESC), 2007Employment:Employment:

Primary Health Care, Kalimantan 1980-1984Primary Health Care, Kalimantan 1980-1984 GP in Husada Hospital 1984-1986GP in Husada Hospital 1984-1986 Cardiologist, Husada Hospital 1991-now Cardiologist, Husada Hospital 1991-now President Director of Husada Hospital 1999-2005President Director of Husada Hospital 1999-2005 Head of Depart of Cardiology, Husada Hospital 1999-nowHead of Depart of Cardiology, Husada Hospital 1999-now

Kegawatdaruratan Jatung Kegawatdaruratan Jatung Infark Miokard AkutInfark Miokard Akut

Dr. Yeo Hans Cahyadi PhD, SpJP, FIHA, FESCDr. Yeo Hans Cahyadi PhD, SpJP, FIHA, FESC

Normal ECGNormal ECG

VES (Ventricular Extra-Systole)VES (Ventricular Extra-Systole)

VES (Ventricular Extra-systole)pada Old Antero-septal MI

Anterior-inferior STEMI

VT (Ventricular Tachycardia)

Ventricular Fibrillation

Cardiac Arrest

DefibrillatorDefibrillator

ATHEROSCLEROSIS

INTRAPLAGUE THROMBUS

PLAGUE RUPTURE

INTRALUMINAL THROBUS

PLAGUE RUPTURE

PROPAGATION THROMBUS

The Vulnerable Plaque

Plaque Disruption

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1990199219941996199820002002

1990ACC/AHA

AMI R.

Gunnar

1994AHCPR/NHLBI

UA E. Braunwald 1996 1999

Rev Upd ACC/AHA AMI T. Ryan

2004 2007 Rev Upd ACC/AHA STEMI E. Antman

2000 2002 2007 Rev Upd RevACC/AHA UA/NSTEMI E. Braunwald; J. Anderson

20042007

Evolution of Guidelines for ACS

2009

2009Upd

ACC/AHA STEMI/PCIF. Kushner

Pathway: Triage and Transfer for PCI (in STEMI)Pathway: Triage and Transfer for PCI (in STEMI)

2009 STEMI Focused Update. Appendix 5

STEMI patient who is acandidate for reperfusion

Initially seen at a PCIcapable facility

Initially seen at a non-PCIcapable facility

Send to Cath Lab for primary PCI(Class I, LOE:A)

Transfer for primary PCI(Class I, LOE:A)

Initial Treatmentwith fibrinolytictherapy (Class 1, LOE:A)

Prep antithrombotic (anticoagulantplus antiplatelet) regimen

Diagnostic angio

Medicaltherapy only

PCI CABG

NOT HIGH RISK

Transfer to a PCI facility may be considered (Class IIb, LOE:C), especially if ischemic symptoms persist and failure to reperfuse is suspected

HIGH RISKTransfer to a PCI facility is reasonable for early diagnostic angio & possible PCI or CABG (Class IIa, LOE:B),

High-risk patients as defined by 2007 STEMI Focused Update should undergo cath (Class 1: LOE B)

At PCI facility, evaluate for timing of diagnostic angio

Mr. SS, 23-03-2011 (9 Ms post PCI)Mr. SS, 23-03-2011 (9 Ms post PCI)

Angina PectorisAngina Pectoris

Cardiogenic shock, BP 85/65 mmHgCardiogenic shock, BP 85/65 mmHg

ECGECG

Mr. SS, ECG pre Primary PCI

Mr. SS, CAG + Primary PCIMr. SS, CAG + Primary PCI

Mr. SS, Primary PCIMr. SS, Primary PCI

Mr. SS, ECG post Primary PCI

Time is MoneyTime is Money

Time is Time is MyocardiumMyocardium

Copyright restrictions may apply.Kim, K. P. et al. Arch Intern Med 2009;169:1188-1194.

Estimated lifetime risk of radiation-induced cancer per 100 000 persons from a single computed tomographic scan to assess coronary artery calcification by age at screening

Copyright restrictions may apply.Kim, K. P. et al. Arch Intern Med 2009;169:1188-1194.

Site-Specific Estimates of the Lifetime Risk of Radiation-Induced Cancer From a Single Coronary Artery Calcification Computed Tomographic Screen at Age 55 Years

Thank youThank you

6666

ACC/AHA 2009 STEMI/PCI Guidelines ACC/AHA 2009 STEMI/PCI Guidelines Focused Update Focused Update

Based on the ACC/AHA Guidelines for the Management of Patients With ST-Elevation

Myocardial Infarction (STEMI) and the ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (PCI): A Report of the ACC/AHA Task Force on Practice Guidelines

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Class I Benefit >>> Risk

Procedure/ Treatment SHOULD be performed/ administered

Class IIa Benefit >> RiskAdditional studies with focused objectives needed

IT IS REASONABLE to perform procedure/administer treatment

Class IIb Benefit ≥ RiskAdditional studies with broad objectives needed; Additional registry data would be helpful

Procedure/Treatment MAY BE CONSIDERED

Class III Risk ≥ BenefitNo additional studies needed

Procedure/Treatment should NOT be performed/administered SINCE IT IS NOT HELPFUL AND MAY BE HARMFUL

shouldis recommendedis indicatedis useful/effective/

beneficial

is reasonablecan be useful/effective/

beneficialis probably recommended

or indicated

may/might be consideredmay/might be reasonableusefulness/effectiveness is

unknown /unclear/uncertain or not well established

is not recommendedis not indicatedshould notis not

useful/effective/beneficialmay be harmful

Applying Classification of Recommendations and Level of Evidence

Class I Benefit >>> Risk

Procedure/ Treatment SHOULD be performed/ administered

Class IIa Benefit >> RiskAdditional studies with focused objectives needed

IT IS REASONABLE to perform procedure/administer treatment

Class IIb Benefit ≥ RiskAdditional studies with broad objectives needed; Additional registry data would be helpful

Procedure/Treatment MAY BE CONSIDERED

Class III Risk ≥ BenefitNo additional studies needed

Procedure/Treatment should NOT be performed/administered SINCE IT IS NOT HELPFUL AND MAY BE HARMFUL

Applying Classification of Recommendations and Level of Evidence

Level A: Multiple populations evaluated; Data derived from multiple randomized clinical trials or meta-analyses

Level B: Limited populations evaluated. Data derived from a single randomized trial or non-randomized studies

Level C: Very limited populations evaluated. Only consensus opinion of experts, case studies, or standard-of-care.