培训课件-PCI围术期抗血小板治疗新进展.ppt

Stable angina N=269 568 Patients on chronic Clopidogrel therapy (10 days) with Primary endpoint: Death MI TVR 4 - 8 hrs 30 days Randomization Placebo ? N=283 Angiography Medical Rx (N=75) CABG (N=57) Clopidogrel 600 mg reload ? N= 285 NSTE-ACS N=167 - NSTE-ACS or Stable angina CK-MB Troponin-I PRU Baseline blood sample PCI 2 hrs 8 and 24 hrs PRU CK-MB Troponin-I PRU PRU ARMYDA-Reload: Study design PCI Reload N=130 PCI Placebo N=139 PCI Reload N=89 PCI Placebo N=78 ? On top of chronic therapy 219 Reload 217 Placebo PCI = 436 EVENT CURVES 30-day MACE and Benefit with Reload ACS – Placebo Stable Angina - Reload ACS - Reload Stable Angina - Placebo ARMYDA-Reload 0 4 8 12 16 20 5 10 15 20 25 30 Days Death/MI/Repeat revascularization (%) P=0.035 (ACS Placebo vs ACS Reload) PCI- 研究： 氯吡格雷预处理减少PCI术前的终点事件发生 * 从随机分组至PCI术前(平均6天)内的终点事件( 心血管死亡/心梗/卒中)的 相对危险度下降 Sabatine MS et al. JAMA, 2005;294:1224-1232 随机化后天数 Percentage with outcome (%) 0 3 4 6 氯吡格雷预处理 (4.0%) 1 5 无氯吡格雷预处理 (6.2%) 38%* p=0.028 2 0 2 4 6 8 入院时立即给予氯吡格雷和溶栓治疗 部分患者随后进行补救或择期PCI，入院至PCI中位时间为6天 2009 ACC/AHA STEMI/PCI指南 I I I IIa IIa IIa IIb IIb IIb III III III I I I IIa IIa IIa IIb IIb IIb III III III I I I IIa IIa IIa IIb IIb IIb III III III IIa IIa IIa IIb IIb IIb III III III 直接PCI或非直接PCI术中或术前至少应立即给予300 mg－600mg氯吡格雷 ACC/AHA 2009 Joint STEMI/PCI Guidelines Focused Update MODIFIED Recommendation I I I IIa IIa IIa IIb IIb IIb III III III I I I IIa IIa IIa IIb IIb IIb III III III I I I IIa IIa IIa IIb IIb IIb III III III IIa IIa IIa IIb IIb IIb III III III ACS患者接受冠脉支架植入术者 (BMS or DES), 氯吡格雷75 mg/天 或普拉格雷10mg/d至少给予治疗12个月; I I I IIa IIa IIa IIb IIb IIb III III III I I I IIa IIa IIa IIb IIb IIb III III III I I I IIa IIa IIa IIb IIb IIb III III III IIa IIa IIa IIb IIb IIb III III III 接受DES的患者可考虑持续氯吡格雷或普拉格雷治疗超过15个月 I I I IIa IIa IIa IIb IIb IIb III III III I I I IIa IIa IIa IIb IIb IIb III III