2013ACCFAHASTEMI指南要點及其临床启示.pptVIP

2013 ACCF/AHA STEMI指南要点及其临床启示 王东琦 西安交通大学医学院第一附属医院 2012年12月17日ACCF、AHA联合发布ST段抬高急性心肌梗死治疗指南，并于2013年1月在JACC、Circulation发表 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction (Circulation). Published on December 17, 2012, available at: /lookup/doi/10.1161/CIR.0b013e3182742cf6 新指南重点放在3个方面 OGara PT, et al. Circulation, 2013;127:1-64. 心肌梗死发生后医疗系统快速启动 重点是对患者尽快实施再灌注治疗 Regional Systems of STEMI Care, Reperfusion Therapy, and Time-to-Treatment Goals Onset of Myocardial Infarction 总缺血时间：每一分钟都有意义 总缺血时间每延长30分钟，1年死亡率增加7.5% De Luca, et al. Circulation. 2004;109:1223-1225. 1994-2001年，共入选1791例行直接PCI的STEMI患者。入选标准：症状发生6小时内，或6-24小时仍存在持续缺血（持续或再发胸痛、ST段持续抬高或再抬高） Regional Systems of STEMI Care, Reperfusion Therapy, and Time-to-Treatment Goals All communities should create and maintain a regional system of STEMI care that includes assessment and continuous quality improvement of EMS and hospital-based activities. Performance can be facilitated by participating in programs such as Mission: Lifeline and the D2B Alliance. Performance of a 12-lead ECG by EMS personnel at the site of FMC is recommended in patients with symptoms consistent with STEMI. Regional Systems of STEMI Care, Reperfusion Therapy, and Time-to-Treatment Goals Reperfusion therapy should be administered to all eligible patients with STEMI with symptom onset within the prior 12 hours. Primary PCI is the recommended method of reperfusion when it can be performed in a timely fashion by experienced operators. EMS transport directly to a PCI-capable hospital for primary PCI is the recommended triage strategy for patients with STEMI with an ideal FMC-to-device time system goal of 90 minutes or less.* *The proposed time windows are system goals. For any individual patient, every effort should be made to provide reperfusion therapy as rapidly as possible. Regional Systems of STEMI Care, Reperfusion Therapy, and Time-to-Treatment Goals Immediate transfer to a PCI-capable hospital for primary PCI i