何奔-药物介入0921南京试题.ppt

溶栓后PCI荟萃2010 EHJ 溶栓后PCI 荟萃2011 EHJ 30d 复合终点 Pharmacoinvasive therapy for ST elevation myocardial infarction in China: a pilot study   我们的经验 2 with no lesions ≥50% diameter stenosis and 1 with unsuitable anatomy did not undergo PCI 35 had successful PCI but 2 failed 6 had TIMI 0-1 34 had TIMI 2-3 50 enrolled and accepted half-dose rt-PA 40(81.6%) Achieved clinical criteria of reperfusion 1 was unwilling to undergo angiography 9(18.4%) underwent rescue PCI 4 had TIMI 2-3 5 had TIMI 0-1 8 had successful PCI but 1 failed Early PCI 75.5% TMPFC: A novel method for myocardium perfusion assessment  Cath Cardiovasc Interv. 2010;75(5):722-32. (IF 2.4) Superior to MBG TMPG with easier low varibility Predict short-term prognosis Cath Cardiovasc Interv 2010;75:733-734 137.5±57.3 110.8±51.3 116.7±52.5 157.0±44.8 n=12 n=8 n=4 n=14 Optimal time of early PCI (Pilot) It’s time to investigate whether reperfusion benefit transfer to clinical one? Conclusion from pilot Rt-PA 50mg reached 76% successful rate(=TIMI2) and is suitable for pharmacoinvasive PCI can be safely performed after rt-PA thrombolysis without increasing bleeding and other complications PCI after rt-PA will further increase epicardial as well as myocardial reperfusion. Although the time window of PCI after lytic still need further elucidated ,our primary results showing that 3-6 hrs is good for reperfusion,epicardial or myocardium. Perspective from pilot Whether epicardial and myocardial reperfusion benefit transfer to clinical endpoint benefit need further study. It’s time to further elucidate whether this pharmacoinvasive strategy is comparable with primary PCI. Larger scale of trial is going to start. ESC 2012 指南 2012ESC指南高度总结 Take Home Message 溶栓与介入的选择4个条件：发病时间，可能的拖延时间，患者本身风险度，年龄与梗死部位 溶栓后可以PCI，不管是否溶成，及时转运至有条件的中心是必要的 溶栓药物必须是短效与纤溶特异性的 溶栓后PCI的时间3小时以上是必须的，但最好12-24h Thank you for your attention The guidelines discuss in detail the decision to take the time from first medical contact