Cath DB ?? ??

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• Cath DB ?? ??
• Admission data
• AMI data
• Discharge data
• Clinical Follow-Up data
• Presented by ???, choijinh_at_yahoo.com

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1. ? ?? ??
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2. ?? ???? ??
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List ?? ?? ? ?? ??
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3. Admission ?? ?? ? ??? ??
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Admission data
Status Outpatient referral ???? ?? Emergency
department ????? ?? Transfer-Acute care
facility ??? ???/CCU/ICU?? ??? ??
Transfer-Non-Acute care facility ??? ???? ??? ??
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Medication data
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History Risk factor
? ????? ?? DM ?? ????? ???? ?? (fasting
glucose gt 140 or HbA1C gt 6.5) HT ?? ?????
???? ?? CRF creatinine gt 2.0 mg/dL Smoking
?? ?? ?? ???? Current smoker Dyslipidemia Meno
pause Previous chronic lung disease ????? ????
?? ??? ??? FHx Premature CAD male lt 45 yr,
female lt 55 yr
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Clinical diagnosis
???? No Sx/No Angina ??? ??? ???? ??????? ???
?? (????, pre-transplantation W/U
?) Atypical Chest Pain ??????? ???? ?? (???? lt
50) Stable Angina ????? ???? (gt50) ?? ACS
Unstable Angina troponin ?? ?? ?? ?? ACS
Non-STEMI troponin ?? ACS STEMI troponin ??,
ST ?? ?? Silent ischemia ????? ????? ??? ??
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Unstable angina classification
Severity by resting chest pain Severity by resting chest pain Clinical circumstances Clinical circumstances Clinical circumstances
Severity by resting chest pain Severity by resting chest pain A B C
Severity by resting chest pain Severity by resting chest pain Secondary to extracardiac condition primary Post-MI (lt 2 wk)
I None IA IB IC
II 48 hr 1 month IIA IIB IIC
III lt 48 hr IIIA IIIB troponin (-) IIIB troponin () IIIC
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Non-invasive test
?? negative positive equivocal incomplete cf
) old MI ???? ?? ? ?? SPECT reversible
perfusion defect () TMT typical ST
depression or elevation DSE reversible
regional wall motion abnormality
MRI evidence of myocardial ischemia (decreased
myocardial perfusion ) coronary
CT significant coronary artery stenosis (gt50)
or evidence of myocardial ischemia (decreased
myocardial perfusion )
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Lab data
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AMI data
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AMI data - time
ER
Cath Lab
ST resolution time
Chest pain ()
Cath Lab Arrival Time
Sx Onset Time
ER arrival time
Thrombolysis time (needle time)
First balloon time
Door-to-Needle time
Door-to-Balloon time
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AMI data, clinical
Killip class 1, 2, 3, 4 AMI PCI Primary PCI
PCI ? reperfusion ?? Rescue PCI failed
thrombolysis ? PCI ? reperfusion ?? Facilitated
PCI ????? thrombolysis ? PCI ? reperfusion
?? (Salvage PCI)
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AMI LV data
LV data Echo, MRI, CT, (LVG) 16 vs 17
segment LV function normal, hypokinesia,
akinesia, dyskinesia
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Discharge status
CABG No CABG Elective pre-planned Urgent lt
24 hr Emergent immediate Salvage CPR
() Transferred for CABG
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Clinical Follow-Up
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Definition of PCI-related terms TVF, TVR, TLR
TVF (target vessel failure) TVR, cardiac death,
or MI not clearly attributed to a vessel other
than the target vessel.
Death or MI of this vessel
TVR (target vessel revascularization) target
vessel revascularization non-TLR
TLR (target lesion revascularization) clinically
-driven revascularization of target lesion
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How to obtain clinical follow-up
Clinical follow-up MACE (major adverse cardiac
event) ? ?? ?? ??? ??/?? ?? revascularization
(PCI/CABG) ?? AMI, CVA ??
MACE (major adverse cardiac event)
MI
death
(clinically-driven) revascularization
CVA
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How to obtain clinical follow-up
(1) ???? ?? ???, ??? ???/????, ???? ??? (2)
??? ???? (?? ??) ????(??) ? ??? (3) ?? ??
(???? ??!)