2012ESCSTEAMI诊治指南更新.ppt

2012ESCSTEAMI诊治指南更新 解放军总医院心血管病中心 杨庭树 2012.09.14 ? ? ? ? ? ? What is new? ? Early Diagnosis Expanded section, atypical presentations ? Cardiac Arrest Expanded section. The role of therapeutic hypothermia and angiography defined. ? Pre Hospital Logistics of Care Role of pre hospital diagnosis, triage and networks highlighted ? Reperfusion strategies Modified recommended maximal time delays, angio post fibrinolysis ? PCI strategies Stent recommendations, anti thrombotic therapy ? Routine therapies and strategies Duration of hospital stay, secondary prevention, duration of anti thrombotic therapy, Evaluation of LV function and viability /guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215 更新指南明确将心肌梗死分为5个类型 I型 自发性心肌梗死； Ⅱ型 继发性心肌梗死； Ⅲ型 心脏性猝死； Ⅳa型 PCI相关性心梗； Ⅳb型 支架内血栓相关心梗； Ⅴ型 冠脉搭桥术相关心梗。 Early Diagnosis Spontaneous myocardial infarction related to atherosclerotic plaque rupture, fissuring, or dissection with resulting intraluminal thrombus in one or more coronary arteries leading to decreased myocardial blood flow with ensuing myocyte necrosis. Myocardial Infarction Type 2 Myocardial infarction where a condition other than CAD contributes to an imbalance between myocardial oxygen supply and/or demand, e.g. coronary artery spasm, tachy- /brady-arrhythmia, anaemia, respiratory failure, hypotension or hypertension. Myocardial Infarction Type 3 Cardiac death with symptoms suggestive of myocardial ischemia and presumed new ischemic ECG changes or new LBBB but death occurring before blood samples could be obtained or before cardiac biomarkers could rise. Myocardial Infarction Type 4a PCI-related MI is defined by elevation of cardiac troponin values 5 X 99th percentile URL. In addition, either (i) symptoms suggestive of myocardial ischemia or (ii) new ischaemic ECG changes or (iii) angiographic findings