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Cath DB 사용 안내 Admission data AMI data Discharge data Clinical Follow-Up data

Cath DB 사용 안내 Admission data AMI data Discharge data Clinical Follow-Up data Presented by 최진호 , choijinh@yahoo.com. 1. 새 환자 추가. 2. 환자 인적사항 입력. List 단추 누른 후 확인 가능. 3. Admission 단추 누른 후 데이터 입력. Admission data. Status Outpatient referral 외래에서 입원

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Cath DB 사용 안내 Admission data AMI data Discharge data Clinical Follow-Up data

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  1. Cath DB 사용 안내 • Admission data • AMI data • Discharge data • Clinical Follow-Up data • Presented by 최진호, choijinh@yahoo.com

  2. 1. 새 환자 추가

  3. 2. 환자 인적사항 입력

  4. List 단추 누른 후 확인 가능

  5. 3. Admission 단추 누른 후 데이터 입력

  6. Admission data Status Outpatient referral 외래에서 입원 Emergency department 응급실에서 입원 Transfer-Acute care facility 타병원 응급실/CCU/ICU에서 전원된 환자 Transfer-Non-Acute care facility 타병원 병실에서 전원된 환자

  7. Medication data

  8. History & Risk factor 각 위험인자의 정의 DM: 이미 진단받거나 치료중인 경우 (fasting glucose > 140 or HbA1C > 6.5%) HT: 이미 진단받거나 치료중인 경우 CRF: creatinine > 2.0 mg/dL Smoking: 현재 또는 최근 흡연하면 Current smoker Dyslipidemia: Menopause: Previous chronic lung disease: 진단받거나 치료중인 만성 폐쇄성 폐질환 FHx Premature CAD: male: < 45 yr, female: < 55 yr

  9. Clinical diagnosis 임상진단 No Sx/No Angina 협심증 환자가 아니면서 관상동맥조영술 시행한 경우 (판막질환, pre-transplantation W/U 등) Atypical Chest Pain 관상동맥병변이 현저하지 않음 (협착정도 < 50%) Stable Angina 관상동맥에 협착병변 (>50%) 있음 ACS: Unstable Angina troponin 음성 또는 매우 낮음 ACS: Non-STEMI troponin 양성 ACS: STEMI troponin 양성, ST 분절 상승 Silent ischemia 무증상이나 심근허혈이 증명된 경우

  10. Unstable angina classification

  11. Non-invasive test 결과 negative positive equivocal incomplete cf) old MI ‘허혈심근 양성’ 의 정의 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 (>50%) or evidence of myocardial ischemia (decreased myocardial perfusion )

  12. Lab data

  13. AMI data

  14. 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

  15. AMI data, clinical Killip class: 1, 2, 3, 4 AMI PCI: Primary PCI : PCI 로 reperfusion 시도 Rescue PCI : failed thrombolysis 후 PCI 로 reperfusion 시도 Facilitated PCI : 의도적으로 thrombolysis 후 PCI 로 reperfusion 시도 (Salvage PCI)

  16. AMI – LV data LV data: Echo, MRI, CT, (LVG) 16 vs 17 segment LV function: normal, hypokinesia, akinesia, dyskinesia

  17. Discharge status CABG No CABG Elective pre-planned Urgent < 24 hr Emergent immediate Salvage CPR (+) Transferred for CABG

  18. Clinical Follow-Up

  19. 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

  20. How to obtain clinical follow-up Clinical follow-up = MACE (major adverse cardiac event) 의 추적 특정 일까지 생존/사망 여부 revascularization(PCI/CABG) 여부 AMI, CVA 여부 MACE (major adverse cardiac event) MI death (clinically-driven) revascularization CVA

  21. How to obtain clinical follow-up (1) 전산검색 외래 방문일, 응급실 방문일/사망여부, 장례식장 방문일 (2) 통계청 사망자료 (매년 연말) 사망원인(코드) 및 사망일 (3) 전화 문의 (사망환자 제외!)

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