2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes

1. 2014 AHA/ACC Guideline for the Management of Patients With
Non–ST-Elevation Acute Coronary Syndromes
DR. JUAN CARLOS BECERRA MARTÍNEZ
Fellow en Cardiología Intervencionista, UMAE HE CMNO
ACC Fellow in-Training
Miembro ESC, EAPCI, SCAI, SOLACI, SOCIME, CCJ
JACC. September 23, 2014. Accepted Manuscript

2. JACC. September 23, 2014. Accepted Manuscript

3. Pathophysiology
JACC. September 23, 2014. Accepted Manuscript

4. Presentation
JACC. September 23, 2014. Accepted Manuscript

5. TIMI Risk Score
JACC. September 23, 2014. Accepted Manuscript

6. GRACE Risk Model
JACC. September 23, 2014. Accepted Manuscript

7. Early Risk Stratification
JACC. September 23, 2014. Accepted Manuscript

8. Cardiac Biomarkers
JACC. September 23, 2014. Accepted Manuscript

9. Medical Management
JACC. September 23, 2014. Accepted Manuscript

10. Medical Management
JACC. September 23, 2014. Accepted Manuscript

11. Medical Management
JACC. September 23, 2014. Accepted Manuscript

12. Medical Management
JACC. September 23, 2014. Accepted Manuscript

13. Aspirin
JACC. September 23, 2014. Accepted Manuscript

14. P2Y12 Inhibitors
JACC. September 23, 2014. Accepted Manuscript

15. GP IIb/IIIa inhibitors
Abciximab: better downstream
JACC. September 23, 2014. Accepted Manuscript

16. Parenteral anticoagulant
JACC. September 23, 2014. Accepted Manuscript

17. JACC. September 23, 2014. Accepted Manuscript

18. JACC. September 23, 2014. Accepted Manuscript

19. Strategies
JACC. September 23, 2014. Accepted Manuscript

20. Non-anginal pain management
JACC. September 23, 2014. Accepted Manuscript

21. Special patient groups
JACC. September 23, 2014. Accepted Manuscript

22. Special patient groups
JACC. September 23, 2014. Accepted Manuscript

23. Special patient groups
JACC. September 23, 2014. Accepted Manuscript

24. Special patient groups
JACC. September 23, 2014. Accepted Manuscript

25. Special patient groups
JACC. September 23, 2014. Accepted Manuscript

26. Special patient groups
JACC. September 23, 2014. Accepted Manuscript

27. Puntos a discutir…
1.- Ya no usar CKMB ni mioglobina en el abordaje diagnóstico
2.- BNP es útil en estratificación
3.- Mejor ticagrelor/prasugrel que clopidogrel
4.- Prasugrel solo si se colocan stents
5.- Mejor eptifibatide/tirofibán que abciximab para terapia “upstream”
6.- Bivalirudina solo en estrategia invasiva
7.- Pacientes con fondoparinux: hacer switch a otro anticoagulante en caso de
cateterismo
8.- La estrategia “conservadora inicial” ahora se llama “guiada por isquemia”

28. Puntos a discutir…
9.- Cuatro estrategias de tratamiento:
- Guiada por isquemia (antes conservadora)
- Invasiva Inmediata (2 hrs)
- Invasiva temprana (24 hrs)
- Invasiva tardía (25-72 hrs)
10.- Se añade la pirámide invertida de analgésicos
11.- B-bloqueadores pueden desencadenar espasmo coronario en
pacientes con uso reciente de cocaína / metaanfetaminas
12.- Nuevas recomendaciones sobre Takotsubo

29. Gracias!