不稳定型心绞痛和非ST段抬高心梗的治疗.ppt

34062 Atherothrombosis v21 Acute Coronary Syndromes: Management of UA/NSTEMI Overview of 2003 Updates to the ACC/AHA Guideline for UA/NSTEMI Assess likelihood of CAD Risk stratification Target therapy: more aggressive treatment in higher-risk patients Anti-ischemic, antithrombotic therapy Invasive vs conservative strategy Discharge planning (risk factor modification and long-term medical therapy) Acute Management of UA/NSTEMI Anti-Ischemic Therapy Oxygen, bed rest, ECG monitoring Nitroglycerin ?-Blockers ACE inhibitors ACC/AHA Class I Recommendations for Antithrombotic Therapy* Aspirin in Acute Coronary Syndromes Aspirin in Acute Coronary Syndromes Indirect Comparisons of ASA Doses on Vascular Events in High-Risk Patients BRAVO: Bleeding By ASA dose CURE: Major Bleeding at 1 year by ASA Dose TIMI IIB/ESSENCE Metanalysis:Enoxaparin vs Unfractionated Heparin TIMI IIB: Early Phase Death/MI/Urgent Revasc INTERACT: Enoxaparin vs Unfractionated Heparin With GP IIb/IIIa Inhibitors A-Phase Study Design 7- and 30-Day Primary EndpointComposite Death, MI and Refractory Ischemia Enox Test vs Outcomes Direct Thrombin Inhibitor Trialists Collaboration Expert Panel Consensus GP IIb/IIIa Inhibitor During Medical Management and After PCI: CAPTURE, PURSUIT, PRISM-PLUS Meta-analysis of IIb/IIIa Inhibition in PCI for 30-Day Mortality IV GP IIb/IIIa Inhibitors in ACS: Death or MI at 30 Days (N=31,402) GP IIb/IIIa Inhibition in Diabetics Intravenous GP IIb/IIIa Antagonists in ACS: Death or MI (at 30 Days) in PCI/CABG 5 Days Cohort and in Medical Treatment Cohort GP Iib/IIIa Inhibitor NSTE ACS Trials Analysis Risk-Adjusted Mortality at 30 Days Mortality by Hospitals’ Use of Early GP IIb/IIIa Inhibitors (N=1189 Hospitals) CURE: Primary End Point MI/Stroke/CV Death CURE: MI/Stroke/CV Death/Severe Ischemia Within 24 Hours of Randomization CURE: Benefit of Clopidogrel + Aspirin Across All TIMI Risk Score Groups PCI-CURE: Study Design PCI CURE: Benefit of Pretreatment With Clop