GP Railway Workshops Heart Week Event Dr Chris Judkins MBBS MClinRes FRACP Interventional Cardiologist WA Cardiology Fiona Stanley Hospital

 What is Coronary Intervention ?  What are the latest developments?  Aftercare post Stenting

 What is it?  How does it work?  What happens after stenting?

 Angiography  Mason Sones accidentally catheterised the LM – cardiac arrest  POBA  Sept , Switzerland, Andreas Gruentzig  Limited by dissections, recoil, acute closure (5%), restenosis  BMS  Introduced 1986 – Palmaz Schatz – approved FDA 1994  Better than POBA (Stress and Benestent-1 trials)  Neointimal hyperplasia 20-30%  DES  Introduced to overcome NIH  Issue of late thrombosis (drug prevents endothelialisation)  DEB  2 available – Useful where a stent is not desirable, ISR etc  Bioabsorbable scaffolds  Polymer of L-lactic acid (PLLA) (others magnesium etc)  Abbott Vascular – ”Absorb” TGA 2014

 Patients prefer Radial (wrist) Access  Back pain  BMI  Unable to lie flat  Less bleeding  Less Mortality  Same day stenting

Access site Bleeding Complications Major and Minor CaseComplicationTreatment Required FEMORAL 1 Pseudoaneurysm and retroperitoneal bleed US compression + transfusion 2 units 2 Haematoma >5cm - Transfusion Prolonged digital comp (3hr) and transfusion 2units 3 Haematoma >5cm - No transfusion Digital compression 90mins 4 Haematoma >5cm - No transfusion Digital compression 40mins 5 Retroperitoneal bleed Wait and watch 6-20Haematoma <5cm Digital compression <30mins RADIAL 21Haematoma <2cm2 nd TR band

 Lifestyle:  Diet  Exercise  Risk Factors:  Diabetes  Hypertension  Cholesterol  Smoking Other Considerations: Work/Driving Medications Comorbidities Obstructive sleep apnea

 Arterial access site  Driving  Diet  Exercise  Work Personal vehicleCommercial vehicle after a heart attack2 weeks4 weeks After a stent2 days4 weeks After bypass grafts4 weeks3 months

Medications 1. Aspirin 2. Clopidogrel (Plavix), Ticagrelor (Brilinta) 3. Statin (eg Atorvastatin) 4. Beta Blocker (eg Metoprolol) 5. ACE Inhibitor (eg ramipril)  Drug eluting stent (DES):12 months  Bare Metal Stent (BMS):3 months  After a heart attack:12 months  Bioresorbable stent:?12 months

Medications 1. Aspirin 2. Clopidogrel (Plavix), Ticagrelor (Brilinta) 3. Statin (eg Atorvastatin) 4. Beta Blocker (eg Metoprolol) 5. ACE Inhibitor (eg ramipril)  Drug eluting stent (DES):12 months  Bare Metal Stent (BMS):3 months  After a heart attack:12 months  Bioresorbable stent:?12 months

Secnario One: 65yo male Not diabetic Normal high blood pressure Smoker Borderline high cholesterol Scenario Two: Lower SBP by 10mmHg Lower cholesterol to target Quit smoking Absolute Risk 28% down to 8%

 Tertiary Hospitals Rehabilitation programs  HeartBeat (Armadale/Kelmscott)   Heart Foundation  My Heart My Life App/Book  Cardiovascular care WA (aka CPRwa)  Hollywood hospital   Perth Heart 