ACS危险分层及抗血小板优化治疗解读.ppt

* 根据C统计量，PURSUIT和GRACE评分对于准确预测第30天和1年复合终点事件的区分性良好，但TIMI评分的C统计量得分没有那么高。 但是，TIMI评分与第30天和1年终点的拟合优度均良好，Hosmer–Lemeshow卡方检验的P值分别为0.803和0.760。 PURSUIT和GRACE评分与第30天终点的拟合优度Hosmer–Lemeshow卡方检验的P值尚可，但没有达到最优。但是，与1年终点的拟合优度均良好。（表4） 另外，还分析了三种风险评分对于原来开发此风险评分使用的标准终点的预测准确度： TIMI 风险评分：预测第14天死亡、心梗或需要急诊血运重建的缺血复发事件的C统计量为0.60 (95% CI: 0.56–0.65) GRACE风险评分：预测院内死亡的C统计量为0.76 (95% CI: 0.72–0.80) PURSUIT 风险评分：终点和随访时间与本研究相同 对于第30天终点事件来说，三种风险评分的预测准确度没有显著差异 对于1年终点事件来说，GRACE风险评分的预测准确度的区分性优于另外两种风险评分，具有统计学显著性差异（表5） 中高危画像： 糖尿病、CKD、STEMI、发生过支架血栓等的风险更高 * * * 支持下述重要信息 阿司匹林的临床最佳剂量为75–150mg /天 背景资料： 血小板释放反应是指在外来因素刺激作用下，激活剂（胶原等）与血小板表面受体结合使血小板发生形态改变并同时释放出胞质中的致密颗粒等，血小板被激活。这张图表明:拜阿司匹灵在 100mg时抑制血小板聚集作用最明显，随着剂量增加，血小板聚集并无明显减少。 * * [XXX] PLATO Study Design The PLATelet inhibition and patient Outcomes (PLATO) is an international, randomized, double-blind, event-driven trial designed to test whether 替格瑞洛 compared with 氯吡格雷 will result in a lower risk of recurrent thrombotic events in a broad patient population with ACS. [James 2009 p. 599 B,C] Patients included those hospitalized for ST-elevation ACS with scheduled primary percutaneous coronary intervention or for non–ST-elevation ACS. [James 2009 p. 602 A] More than 18,000 patients were enrolled and randomly assigned to oral maintenance treatment with 替格瑞洛 90 mg twice daily or 氯吡格雷 75 mg once daily as early as possible after the index event. [James 2009 p. 603 A] Patients in the 替格瑞洛 group received a loading dose of 180 mg of 替格瑞洛. [James 2009 p. 603 A] Patients who did not receive either a loading dose of open-label 氯吡格雷 or 氯吡格雷 or ticlopidine for ≥5 days before randomization received a 300-mg loading dose of 氯吡格雷. [James 2009 p. 603 A] Otherwise, a maintenance dose of 氯吡格雷 was their first dose [James 2009 p. 603 A] Patients undergoing PCI received an additional 300-mg loading dose of 氯吡格雷 at the discretion of the investigator [James 2009 p. 603 A] All patients received ASA 75 mg to 100 mg daily unless they were intolerant. A loading dose of 325 mg was