From A to Z.

Acute Coronary
Syndrome (ACS) Management
based on Latest Guideline
Budi Yuli Setianto,
Department Cardiology and Vascular Medicine, Faculty of
Medicine UGM – Sardjito Hospital Yogyakarta
Curriculum Vitae
Name:
Prof. Dr. dr. Budi Yuli Setianto, SpPD, KKV, SpJP(K), FIHA, FINASIM, FAsCC, FAPSIC, FSCAI
Current Position:
Head of Department of Cardiology and Vascular Medicine Gadjah Mada University School of Medicine – Sardjito Hospital
Yogyakarta
Education:
Medical Student: Faculty of Medicine University of Gadjah Mada 1982
Internist: Faculty of Medicine University of Gadjah Mada 1995
Cardiologist: Faculty of Medicine University of Indonesia 1999
Cardiology consultant: The Indonesian Society of Internal Medicine 2000
Cardiology Intervention: Indonesian Society of Interventional Cardiology – Indonesian Heart Association 2005
FIHA: Fellow of Indonesian Heart Association 1999
FINASIM: Fellow of Indonesian Society of Internal Medicine 2009
FAsCC: Fellow of Asean Colege of Cardiology 2010
PhD: 26 Mei 2012
FAPSIC: Fellow of Asia Pacific Sociiety Interventional Cardiology 2012
Prof: 01 February 2017
FSCAI: Fellow of The Society for Cardiovascular Angiography and Interventions 2019
Course:
Advance Cardiology Life Support: Jakarta, 1997
IVUS course: Singapore, 2007
Bifurcation Course: Kuala Lumpur, 2009
Rotablator Course: Jakarta, 2010
CTO Workshop Yogyakarta 2012
Organization:
Member of IDI, Member of IHA, Member of INASIM, Faculty Members of Asean Colege of Cardiology , Faculty Members of Asia
Pacific Sociiety Interventional Cardiology, Faculty Members of Society for Cardiovascular Angiography and Interventions.
 Epidemiology

The three major clinical manifestations of

atherosclerotic CVD (Cardio Vascular Disease) are:

CHD (Coronary Heart Disease)

CVA (Cerebro Vascular Accident)
PVD (Peripheral Vascular Disease)

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Leading cause of death

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Percentage Breakdown of
Death From CVD
Atherosclerosis and
Inflammation

Monocyte Vessel Lumen

LDL

Adhesion Endothelium
MCP-1
Molecules LDL
Intima
Modified
Cytokines LDL Growth Factors
Metalloproteinases

Cell Proliferation
Macrophage
Foam Cell Matrix Degradation
Ross R. N Engl J Med 1999;340:115-126.
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 Atherosclerosis Timeline
Adapted from Stary HC et al. Circulation 1995;92:1355-1374.

Foam Fatty Intermediate Fibrous Complicated

Cells Streak Lesion Atheroma Plaque Lesion/Rupture

Endothelial dysfunction
From first decade From third decade From fourth decade
Smooth muscle Thrombosis,
Growth mainly by lipid accumulation and collagen haematoma
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Plaques
Vulnerable plaques
Thin fibrous cap
Large lipid core
High macrophage content

Stable plaques
Thick cap
Dense extracellular matrix
Less lipid rich core

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 Acute Myocardial Infarction

Davies MJ. Heart 2000;83:361–366

The spectrum of ACS

Hamm CW, et al. European Heart Journal (2011) 32, 2999–3054

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Brian, GW et al. Critical Pathways in Cardiology17(3):114-138, September 2018.
Initial ECG as a triage tool
in patients with chest pain.

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Brian, GW et al. Critical Pathways in Cardiology17(3):114-138, September 2018.

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Brian, GW et al. Critical Pathways in Cardiology17(3):114-138, September 2018.

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Brian, GW et al. Critical Pathways in Cardiology17(3):114-138, September 2018.
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Brian, GW et al. Critical Pathways in Cardiology17(3):114-138, September 2018.
Time to treatment is
critical in STEMI

Brian, GW et al. Critical Pathways in Cardiology17(3):114-138, September 2018.

 ST-segment elevation myocardial
infarction guidelines for initial antiplatelet
therapy by reperfusion strategy.

Brian, GW et al. Critical Pathways in Cardiology17(3):114-138, September 2018.

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ACCF/AHA 2014 NSTE-ACS
antiplatelet therapy by treatment
strategy.

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NSTE-ACS antiplatelet
therapy by treatment strategy.

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Master treatment algorithm for
duration of P2Y12 inhibitor therapy
in patients with CAD treated with
dual antiplatelet therapy.

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Master treatment algorithm for duration of
P2Y12 inhibitor therapy in patients with
CAD treated with dual antiplatelet therapy.

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Summary of Major Trials of Radial

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Changes in Guideline Recommendations
for Multivessel vs. Culprit Artery–Only PCI
in Patients With STEMI From the 2015
Focused Update to the STEMI Guidelines

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Management Strategies for Patients Presenting
With NSTEMI by Presenting Signs and
Symptoms Adapted From the 2015 Focused
Update to the STEMI Guidelines

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Management Strategies for Patients Presenting
With NSTEMI by Presenting Signs and
Symptoms Adapted From the 2015 Focused
Update to the STEMI Guidelines

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Key elements of successful
discharge and post–acute care
follow-up.

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Example discharge medication
schedule from the UK HealthCare.

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Activities in ACS Transitional
Care Management Clinic

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Classification of MRP

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