GP IIbIIIa抑制剂在UANSTEMI中的应用PPT课件.pptVIP

Dispelling the Myths: GP IIb/IIIa Inhibitors in UA/NSTEMI Management Learning Objectives Demonstrate the role of anti-platelet and anti-thrombin agents in the management of unstable angina (UA)/non-ST-segment elevation myocardial infarction (NSTEMI), including a review of the clinical benefits of the early use of GP IIb/IIIa inhibitors and their role in improving outcomes as well as their specific effects on high-risk UA/NSTEMI patients with diabetes Explore the role of platelet-leukocyte conjugation in UA/NSTEMI Discuss the presence of inflammatory biomarkers in patients with UA/NSTEMI Review the ACC/AHA guidelines for GP IIb/IIIa use Case Presentation: History and Exam CC: Chest pain HPI: 66-year-old woman presents to the ER complaining of several episodes of chest pain lasting 10-12 minutes each PMH: Stable angina treated with PRN SL NTG; type 2 diabetes x 8 years managed with a sulfonylurea; hypercholesterolemia x 12 years managed with a statin; 40-pack-year smoker Exam: Slightly overweight; BP 150/94 mm Hg; HR 78, regular Evaluation: EKG - 1.5 mm ST-segment depression in precordial leads during chest pain episodes; troponin I level 2.1 ng/ml (nl 0.05 ng/ml) Risk Stratification in UA/NSTEMI: TIMI Risk Score This Patient Is High-Risk Overview of 2002 Update to the ACC/AHA Guidelines 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) Case Presentation: Plan of Action A cardiologist is consulted and the patient is admitted at 10 pm; she is scheduled for an angiogram and possible PCI with stent insertion at 7 am the following morning How Would You Manage this Patient for the Next 9 Hours? Antithrombotic Therapy Is Key to Maximizing Outcomes in UA/NSTEMI There is confusion as to which agents to use and whether they are safe when used in