钙离子拮抗剂在急性冠脉综合征治疗中地位再认识.pptVIP

讨论 您认为钙离子拮抗剂在ACS治疗中的地位如何？ 钙离子拮抗剂长效制剂和短效制剂在治疗ACS中的区别？ 您在临床实践中，对钙离子拮抗剂在ACS应用时，和指南推荐有什么不同？ * ACTION研究中有52％的患者为高血压人群，在最新公布的ACTION高血压亚组分析中拜新同使这部分患者的一级终点下降13％，心血管原因导致的死亡可以下降17％。 * 来看看NORMALISE研究设计， 274例患者在冠状动脉介入或造影时进行IVUS和定量分析,然后随机分成3组,分别接受氨氯地平、依那普利或安慰剂治疗 ,24个月后重复IVUS和冠状动脉定量分析，观察动脉粥样硬化斑块进展情况 * CAMELOT研究主要终点是比较氨氯地平组和安慰剂组心血管不良事件的发生率。 心血管不良事件包括非致死性心肌梗死、心脏骤停行复苏术、冠状动脉血运重建术、因心绞痛住院、因充血性心力衰竭住院、致死性或非致死性脑卒中或短暂脑缺血发作(TIA)以及任何新发外周血管病变。 次要终点包括所有原因导致的死亡和已行冠脉支架置入术者需行血运重建术的发生率。 NORMALISE研究的主要终点为动脉粥样硬化斑块体积变化百分比 * Results—NORMALISE: IVUS Remember that the randomized population was 431 patients with 141 in the NORVASC arm, 146 in the enalapril arm, and 144 in the placebo arm. The intent-to-treat population was 274 patients with 91 patients in the NORVASC arm, 88 in the enalapril arm, and 95 in the placebo arm. The IVUS results provide valuable insight into the effects of NORVASC on the progression of atherosclerotic plaque. Primary end point (percent change from baseline in percent atheroma volume): When comparing the plaque progression between groups there was no significant difference. But there was a trend toward reduced progression in the NORVASC group compared with placebo (P=0.12) The change in percent atheroma volume from baseline was: 0.5±3.9% for NORVASC (P=0.31) 0.8±3.7% for enalapril (P=0.08) 1.3±4.4% for placebo (P=0.001) The results from baseline show that there was: No significant change in plaque for the NORVASC arm Some increase in plaque for the enalapril arm Significant increase in plaque for the placebo arm * Results—NORMALISE: IVUS Remember that the randomized population was 431 patients with 141 in the NORVASC arm, 146 in the enalapril arm, and 144 in the placebo arm. The intent-to-treat population was 274 patients with 91 patients in the NORVASC arm, 88 in the enalapril arm, and 95 in the placebo arm. The IVUS results provide valuable insight into the effects of NORVASC on the progression of atherosclerotic plaque. Primary end point (percent change from b