急诊PCI治疗要点指南.ppt

* May be useful in STEMI patients with short ischemic times and large clot burdens * * DEBATER研究 阿昔单抗组及对照组30天靶血管重建失败（TVF）发生率 阿昔单抗组及对照组1年MACE发生率 AMI患者于急救车或基层医院诊断并给予 ASA + 600 mg 氯吡格雷 +静脉肝素 Angiogram 替罗非班* 安慰剂 转运 PCI center Angiogram Tirofiban provisional Tirofiban cont’d ON-TIME -2 N=984 6/2006-11/2007 PCI *Bolus: 25 μg/kg 0.15 μg/kg/min infusion PCI术前后ST段回落情况 Ongoing Tirofiban In Myocardial Infarction Evaluation 14.3±9.1 12.1±9.4 5.9±8.1 4.8±6.3 14.5±9.1 10.9±9.2 4.4±5.3 3.3±4.3 0.002 0.022 0.028 p=0.84 [mm] 随机时 造影前 术后60分钟 术后90分钟 30天无事件生存率 Ongoing Tirofiban In Myocardial Infarction Evaluation P = 0.013 74.0% 66.7% 1 年无事件生存率 P = 0.007 open label double-blind, n = 1.155 *   It is reasonable to start treatment with glycoprotein IIb/IIIa receptor antagonists at the time of primary PCI (with or without stenting) in selected patients with STEMI: abciximab tirofiban and eptifibatide Use of Glycoprotein IIb/IIIa Receptor Antagonists in STEMI 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 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 Modified Recommendation IIb/IIIa受体拮抗剂尚未过时 大剂量氯吡格雷额外收益 谢 谢！ 北京朝阳医院 Beijing Chaoyang Hospital Evidence exists that expeditious restoration of flow in the obstructed infarct artery after the onset of symptoms in patients with STEMI is the key determinent of short- and long-term outcomes regardless of whether 再灌注治疗 is accomplished by 溶栓 or PCI. Efforts should be made to shorten the time from recognition of symptoms by the patient to contact with the medical system. * P=0.001 for mortality/reMI en P=0.005 for mortality * Both associations p=0.001 急诊PCI治疗要点 首都医科大学附属 北京朝阳医院心脏中心 王乐丰 急性心肌梗塞治疗的目标: 缩小梗塞面积 保护心功能 防治并发症 降低死亡率 Time Dependent Wavefront of Necrosis 无论何种血运重建方式，都应强调： 时间就是心肌， 时间就是生命 症状识别 呼叫急救系统