Pci guideline

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Text of Pci guideline

1: meta-analysis randomized controlled clinical trials 3: descriptive poor design controlled clinical trial 2: systematic review controlled clinical trials 4: (consensus)

1

(Percutaneous Coronary Intervention, PCI)

+/- ++ - + - -

2

- 6 - 10 - 11 - 13 - 17 - 18 - 20 - 21 - 24 Chronic stable angina pectoris - Stable Angina Pectoris 26 -

left main coronary artery disease 27 (Chronic total occlusion) 31 33

- Chronic stable angina pectoris Aspirin Cilastazol 34

Glycoprotein IIb/IIIa 37 - PCI 39 - 40 ST segment (STEMI)

1: meta-analysis randomized controlled clinical trials 3: descriptive poor design controlled clinical trial 2: systematic review controlled clinical trials 4: (consensus)

3

- 52 ST segment (STEMI) 12 48 . - 53 24 (Recent myocardial infarction) - 55 STEMI (Rescue PCI after failed thrombolysis) - 57 - PCI 58 - 60 STEMI

Aspirin Cilastazol, ADP antagonist, Glycoprotein IIb/IIIa heparin, Unfractionated heparin, low molecular weight heparin

- 64 unstable angina NSTE-ACS - NSTE-ACS (Invasive strategy) 66 (Conservative strategy) - NSTE-ACS

Low molecular weight heparin 71 Glycoprotein IIb/IIIa inhibitor 76

- Drug Eluting Stent (DES) 79

+/- ++ - + - -

4

(Percutaneous Coronary Intervention, PCI)

, ,

1: meta-analysis randomized controlled clinical trials 3: descriptive poor design controlled clinical trial 2: systematic review controlled clinical trials 4: (consensus)

5

(Percutaneous Coronary Intervention, PCI)

,

. . . .

+/- ++ - + - -

6

(Percutaneous Coronary Intervention, PCI)

2535

(percutaneous coronary intervention) (balloon catheter) 41 25 150-160 PCI 10,000 (diagnosis-related group)

1: meta-analysis randomized controlled clinical trials 3: descriptive poor design controlled clinical trial 2: systematic review controlled clinical trials 4: (consensus)

7

1.

(PCI) (coronary stent implantation)

2.

3.

4.

1.

2.

3.

+/- ++ - + - -

8

4.

Guidelines for Percutaneous Coronary Interventions 2005 European Society of Cardiology Update for Percutaneous Coronary Intervention ACC/AHA/SCAI 2005 2 (Full text) electronic Medline Embase 2005 2007 randomized clinical trials meta analysis

Evidence table considered judgment on quality of evidence (Clinical Expert Consensus)

1: meta-analysis randomized controlled clinical trials 3: descriptive poor design controlled clinical trial 2: systematic review controlled clinical trials 4: (consensus)

9

(Interventional cardiologist)

+/- ++ - + - -

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(Quality of Evidence) 1 meta-analysis systematic review

randomized controlled clinical trials well designed randomized controlled clinical trial

2 systematic review controlled clinical trials well designed controlled clinical trial cohort study, case- control study

3 descriptive studies controlled clinical trial

4 (consensus)

(Strength of Recommendation)

++

+

+/-

- - -

1: meta-analysis randomized controlled clinical trials 3: descriptive poor design controlled clinical trial 2: systematic review controlled clinical trials 4: (consensus)

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1. High-Resolution Contrast Fluoroscopy (Intraaortic balloon pump) (Temporary Pacemaker)

2.

3.

4. 5.

400

75 200-400

75 200

75

+/- ++ - + - -

12

150

6. 500

7.

1. 75 2. 3.

4.

1-2 5.

6.

500 ) 7.

1: meta-analysis randomized controlled clinical trials 3: descriptive poor design controlled clinical trial 2: systematic review controlled clinical trials 4: (consensus)

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( informed consent )

8.

9.

10.

1. 2. 3. 4.

1. (complication) 2. 3.

+/- ++ - + - -

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Left main coronary artery disease Severe aortic dissection

4.

1. 2.

3. 4.

1.

epicardium 20

2. (diagnostic coronary arteriography) 1%

3. (interventional) 3%

4. () (catheterization) 150 1 intervention 75 1 400 intervention ( < 75 / )

( > 600 / ) 200

1: meta-analysis randomized controlled clinical trials 3: descriptive poor design controlled clinical trial 2: systematic review controlled clinical trials 4: (consensus)

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Primary PCI 11 primary PCI 36 ( =2) 50 1 75

5.

1. 2. steroid

( antihistamine) 24 non-ionic 3. hydration non-ionic acetylcysteine

nephrotoxicity 4. Metformin

Creatinine 48

5. 5.1 5.2 Warfarin INR

1.8

+/- ++ - + - -

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5.3 Warfarin INR 1.8 K Fresh frozen plasma

5.4 Heparin 5.5 activated clotting time (ACT) 300 Glycoprotein IIb/IIIa inhibitors 200-250 ACT 175

1.

2.

Echocardiography (Provocative test) 1)

constrictive pericarditis restrictive cardiomyopathy 2) afterload Maximal intraventricular gradient Hypertrophic cardiomyopathy Aortic stenosis low output & normal or near normal pressure

gradient 3) (

) 4) Pulmonary vasodilators

3.

1: meta-analysis randomized controlled clinical trials 3: descriptive poor design controlled clinical trial 2: systematic review controlled clinical trials 4: (consensus)

17

Percutaneous closure device collagen plug, suture device Hematoma pseudoaneurysm 7

(Informed consent)

( ad hoc PCI )

+/- ++ - + - -

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1. 1

1 2.

2.1

2.2 scrub 2.3 2.4

3.

4.

1: meta-analysis randomized controlled clinical trials 3: descriptive poor design controlled clinical trial 2: systematic review controlled clinical trials 4: (consensus)

19

1. (As Low As Reasonable Achievable,

ALARA) 2. DNA Cell 3. 0.1rem/year

0.004-0.016 rem/case NCRPM = 5 rem/year rem exposure x ( 50 rems )

4. 20% 0.04% x rem

5. 0.05 rem / 0.5 rem

6. Radiation exposure X-ray film badge transluminsecent dosimeter (TLD) badges ( ring dosimeter )

7. digital-only cine runs image intensifier

8. fluoroscopy cine

9. left anterior oblique (LAO) cranial view Right anterior oblique (RAO) caudal view 6 X-ray

10. collimation

+/- ++ - + - -

20

..1977

1. (stent) (elastic recoil) (scaffold coronary dissection)

2. (drug elut