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Managing AMI – much work still to do?

EXPERTS WORKSHOP ON EARLY TREATMENT STRATEGIES FOR ACUTE MYOCARDIAL INFARCTION FOR THE MIDDLE EAST COUNTRIES FEBRUARY 26 TH -28 TH 2005 / DUBAI, UAE SPONSORED BY BOEHRINGER INGELHEIM. MONDAY, 28 th FEBRUARY – SESSION 3. Managing AMI – much work still to do?. Patrick Goldstein.

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Managing AMI – much work still to do?

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  1. EXPERTS WORKSHOP ON EARLY TREATMENT STRATEGIES FOR ACUTE MYOCARDIAL INFARCTIONFOR THE MIDDLE EAST COUNTRIES FEBRUARY 26TH -28TH 2005 / DUBAI, UAE SPONSORED BY BOEHRINGER INGELHEIM MONDAY, 28th FEBRUARY – SESSION 3 Managing AMI – much work still to do? Patrick Goldstein

  2. Can We Now Imagine Where Are Our Different Roles in the Modern Management of Acute MI?

  3. The EP Clearly Has a Place in the Treatment on scene at the dispatching center at the ER but is that all ?

  4. It Is Not a Question of EP or Cardiologists… …but the common aim of a multidisciplinary team implementing a strategy of participation and collaboration so • acting on the emergency call : yes • treating patients on scene : yes • transporting patients in a difficultposition : yes but

  5. Together • promote clinical research • create and maintain documentation • build evaluation tools: common registers • training for coronary emergencies • ambulance crews • paramedics • nurses • students • physicians • promote media campaigns • promote new participative and combined strategies

  6. Cardiology and Emergency Medicine united we standdivided we fall W.B. Gibler Department of Emergency Medicine Cincinnati E.J. Topol Department of Cardiology Cleveland B. Holfroyd Department of Emergency Medicine Edmonton P.W. Armstrong Department of Emergency Medicine Edmonton Ann. Emerg. Med 2002 ; 39 : 164-167

  7. Study Design Randomise AMI open label ASA UFH (bolus) TNK (Group A) ASA UFH (bolus) No lytic (Group B) n = 2000 n = 2000 Cath lab Angiography / PCI(immediate) Stent / clopidogrel (optional) Heparin as routinely used NOGP IIb/IIIa inhibitors, (only bail-out at investig. discretion) Angiography / PCI(immediate) Stent / clopidogrel (optional) Heparin as routinely used GP IIb/IIIa inhibitors can beused at investig. discretion

  8. Combined Therapy in the “Real World” • Organise pre-hospital fibrinolysis • Define High Volume Centers for rescue PCI • Availability 24 h / 24 h • Direct admission to Cath Lab • Define candidates for combined therapy • Written protocols • Risk / Time to Cath Lab / Ambulance or helicopter • Validate the strategy each year

  9. Proposal • Education of health care providers • Clinical investigation • Improving routine care • Creation of site-specific and multicenter databases • Subspecialisation within emergency medicine and cardiology

  10. So...Some Keys to Success • Enough health care providers • Comprehensive institutions • Evaluation • Training and Teaching • Information • and Communication and… € or $

  11. Reperfusion During the Last Decade 40 Total Reperfusion 30 Fibrinolysis 20 % p = 0.0001 10 PCI 0 90 91 92 93 94 95 96 97 98 99 YEARS (Rogers et al. J Am Coll Cardiol 2000; 36: 2056-63)

  12. Cardiologists and Emergency Physicians Definitive progress for the patients but maybe also for the doctors whose progress together is even better as they get to know each other better A lobby or a task force ?EUROPE AND UAE and may be the planet IS SO SMALL

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