1. GP Superclinic@Midland Railway Workshops Heart Week Event Dr Chris Judkins MBBS MClinRes FRACP Interventional Cardiologist WA Cardiology Fiona Stanley Hospital www.perthheart.com

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

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

6.  Angiography  1960 -Mason Sones accidentally catheterised the LM – cardiac arrest  POBA  Sept 16 1977, 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

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

9. 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

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

11.  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

12. 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

13. 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

14. 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%

15.  Tertiary Hospitals Rehabilitation programs  HeartBeat (Armadale/Kelmscott)  www.baml.com.au/HB www.baml.com.au/HB  Heart Foundation  My Heart My Life App/Book  Cardiovascular care WA (aka CPRwa)  Hollywood hospital  www.cprwa.com.au www.cprwa.com.au  Perth Heart  www.perthheart.com www.perthheart.com