从指南到临床实践 看ACS的抗栓治疗.pptVIP

CRUSADE研究结果与临床试验比较实际的ACS早期死亡率更高 在采用不同治疗策略的NSTEMI/UA患者中氯吡格雷75mg治疗的1年终点事件*发生率均明显降低 CLARITY研究结果在包括溶栓和ASA标准治疗的基础上氯吡格雷75mg可使STEMI患者30天临床事件*的风险相对降低20% ACC/AHA处理UA/NESTEMI的指南 临床实践与指南的差距 ACS患者急性期药物使用情况 在最初的24小时内，无禁忌症的患者中的比例 遵循指南对临床结果的影响 “遵从指南”对降低院内死亡率 影响 STEMI远期死亡率的因素 “遵从指南”的药物使用对1年死亡率的影响 氯吡格雷75mg对STEMI出院存活者1年死亡率的影响– ACOS 注册研究 氯吡格雷75mg治疗降低STEMI出院存活者1年死亡率– ACOS 注册研究 搭建科学研究和临床实践的桥梁 This slide is taken from a presentation made by Dr. Gray Elrodt from Berkshire Medical Center in western Massachusetts. At Berkshire Medical Center, their goal is 100% implementation of the interventions. They view anything less than 100% as a “medical error,” and that patient’s treatment is discussed at mortality and morbidity rounds – just like any other medical mistake. In Massachusetts, the GWTG intervention team estimated that if the interventions were implemented with every patient, every time, they estimated that they would save 782 patients annually from death or another coronary event. We have all the evidence that demonstrates what will impact efficacy, and the development of guidelines. Effectiveness is where it really happens. There is a “big gulf” between the two as demonstrated in this slide – and how do we bridge the gap between efficacy and effectiveness. The alligators represent what can happen – and who, and what, are impacted if we don’t effectively implement the guidelines. Our patients are impacted; third party payors, HCFA and accreditation agencies like JCAHO will be looking at how hospitals improve quality of patient care. This is a process-change. 从德国进行的ACOS注册研究的结果来看，AMI存活出院的患者，接受两联抗血小板治疗能明显提高患者1年的生存率 。 Aims We sought to assess the effect of clopidogrel on clinical events 1 year after discharge in survivors of ST-elevation myocardial infarction (STEMI) in clinical practice. Methods and results We analysed data of consecutive survivors of acute STEMI and either concomitant therapy with aspirin or aspirin plus clopidogrel at discharge, who were prospecti