AHA、ACCSTEMIandPCIRecommendation.ppt

AHA/ACC2009STEMI and PCI Recommendation 北京世纪坛医院心内科 Outline 1 Recommendations for The Use of Medicine 2 Recommendation for PCI 3 Other Recommendations Recommendations for the use of medicine 1 Glycoprotein IIb/IIIa Receptor Antagonists 2 Thienopyridines 3 Parenteral Anticoagulants Recommendations for the Use of Glycoprotein IIb/IIIa Receptor Antagonists〈1〉 Class IIa It is reasonable to start treatment with glycoprotein IIb/IIIa receptor antagonists (abciximab[Level of Evidence: A], tirofiban [Level of Evidence: B] or eptifibatide [Level of Evidence: B])at the time of primary PCI (with or without stenting) in selected patients with STEMI. Modified recommendation (class of recommendation changed from IIb to IIa for tirofiban and eptifibatide). Recommendations for the Use of Glycoprotein IIb/IIIa Receptor Antagonists〈2〉 Class IIb The usefulness of glycoprotein IIb/IIIa receptor antagonists (as part of a preparatory pharmacological strategy for patients with STEMI before their arrival in the cardiac catheterization laboratory for angiography and PCI) is uncertain .(Level of Evidence: B) Modified recommendation (text modified; level of evidence changed from C to B). Recommendations for the Use of Thienopyridines 〈1〉 Class I A loading dose of thienopyridine is recommended for STEMI patients for whom PCI is planned. Regimens should be 1 of the following: a At least 300 to 600 mg of clopidogrel? should be given as early as possible before or at the time of primary or nonprimary PCI. (Level of Evidence: C) b Prasugrel 60 mg should be given as soon as possible for primary PCI . (Level of Evidence: B) Recommendations for the Use of Thienopyridines 〈2〉 c For STEMI patients undergoing nonprimary PCI, the following regimens are recommended: (i) If the patient has received fibrinolytic therapy and has been given clopidogrel, clopidogrel should be continued as the thienopyridine of choice (Level of Evidence: C); (ii) If the patient has received fibrinolytic thera