指南,实践,pci时机.pptVIP

Late PCI ( recommendations) PCI suitable and re-MI Ⅰ C PCI suitable and onging ischaemia Ⅰ B PCI suitable and cardiogenic shock or hemodynamically unstable Ⅰ B Heart failure(LVEF≤40%), severe arrhythmias. Ⅱa C PCI of a hemodynamically significant stenosis in a patent infarct artery 24 hours after STEMI Ⅱb C PCI of a totally occluded infarct artery 24h after STEMI is not recommended in asymptomatic patients with 1- or 2-vessel disease if they are hemodynamically Ⅲ A and electrically stable and do not have evidence of severe ischemia. recommendations class level STEMI management ＜12h STEMI patients PCI-capable hospital Non-PCI-capable hospital no early reperfusion ＞3h, ＜12h transfer fibrinolysis success ＜24h ＞24h yes no elective PCI Conservative therapy PCI Rescue PCI Primary PCI fail ischaemia evaluate (ESC 2008) Reperfusion strategies Angiography for STEMI ESC 2008 Gap: between clinical practice and guidelines GRACE (Global Registry of Acute Coronary Events) 24,189 patients enrolled at 73 hospitals 1999-2006 PCI in STEMI 53.7% , non- STEMI 32.5% PCI procedures on STEMI were more likely to be performed in low- (40%) than medium- (35%, ) or high-risk patients (25%, ). Heart. 2007 Feb;93(2):177-82. Prospective observational study of acute coronary syndromes in China: practice patterns and outcomes. 2004 - 2005, data were collected from 2973 patients admitted to 51 hospitals in 18provinces STEMI 43%; non-STEMI 57% PCI in low-