ACS介入策略__培训课件.ppt

THANK YOU! Early invasive vs. early conservative strategies Early invasive: early coronary arteriography followed by revascularization as indicated by arteriographic findings Early conservative: catheterization, and if indicated, revascularization, only in the event of failure of medical therapy UA NSTEMI Benefit of Intervention 7.6 8.3 9.6 14.5 0 5 10 15 Patients (%) Conservative (n=915) Death/MI at 1 year Death/MI/RA at 4 months P=0.001 RR 0.66 [0.51–0.85] P=NS RR, risk ratio Intervention (n=895) * 6-month mortality for UA/NQMI and ST ? MI When patients presenting with UA/NQMI are treated with aspirin plus heparin, myocardial injury can occur due to the inadequacy of these therapies in preventing platelet aggregation. Patients who have experienced myocardial injury are at high risk of cardiac morbidity and mortality over time. The inadequacy of acute treatment with aspirin and heparin is highlighted by the fact that at 6 months patients who presented initially with ST-segment depression UA/NQMI and who were managed with aspirin plus heparin during initial hospitalization experience higher incidence of death than patients who presented with ST ? MI and were treated with fibrinolytics. This indicates the need for more potent therapies for UA/NQMI to prevent early MI and resultant long-term mortality. * * * * By 4 months, significantly fewer patients assigned intervention experienced a primary endpoint [i.e. death, myocardial infarction (MI) or refractory angina (RA)]. The second prespecified endpoint (i.e. death or MI within 1 year) occurred with similar frequency in the conservative and intervention groups, suggesting that the principal benefit of intervention was on the incidence of RA. However, significantly fewer non-procedure-related MIs occurred in the intervention group during follow-up (30 vs 52, P=0.019). 非ST断抬高性 急性冠脉综合的介入治疗 广东省心血管病研究所 　　　　陈纪言 RITA-3-results intervention conservative RR(95%CI) p n=895 n=915 4-Month D/MI/Angina 86(9.6%) 133(14.5