STEMI指南解读_韩雅玲.ppt

OASIS-6：主要终点（STEMI患者累积死亡） ExTRACT-TIMI 25研究显示，无论病人做PCI与否，均能从依诺肝素获益;做PCI的病人，依诺肝素与普通肝素相比相对风险下降23% * * High risk based on definitions used in CARESS-IN-AMI and TRANSFER-AMI * * * * Meta-analysis of randomized trials comparing isosmolar iodixanol with LOCM. 16 trials in 2 763 patients. Subanalyses showed variations in relative renal safety by specific LOCM: A reduction in CIN was observed when iodixanol was compared with ioxaglate, the only ionic LOCM, (RR 0.58, CI 0.37 to 0.92, P=0.02) and with iohexol, a nonionic LOCM, (RR 0.19 to 0.38, P0.01), but no difference was noted in comparisons of iodixanol with iomeprol, iopamidol, iopromide, or ioversal. * *Stenting for unprotected left main coronary artery (uLMCA) disease is relatively more favorable for patients with isolated LMCA lesions or LMCA plus single vessel disease, for patients with ostial or mid-LMCA lesions, and for patients with factors (such as severe lung disease, prior thoracic surgery, or poor bypass graft targets) that would make CABG high risk or unlikely to be successful. Conversely, CABG for uLMCA may be relatively more favorable for patients with LMCA plus multi-vessel disease, distal/bifurcation LMCA lesions, or low surgical risk with good chance of technical success. ExTRACT-TIMI 25 研究的20,479例患者中，有10,256例使用了依诺肝素，10,223例使用了普通肝素。30天内依诺肝素组有2,279例进行了PCI，普通肝素组有2,404例进行了PCI。总体来看，使用依诺肝素比使用普通肝素相对风险（RRR）下降17%。在30天内进行PCI，依诺肝素组的死亡率/再发心梗率为10.7%，普通肝素组的死亡率/再发心梗率为13.8%，RRR降低了23%。所以，使用依诺肝素对实施PCI是有好处的。 UFH + GPI (N=1802) Bivalirudin (N=1800) HR [95%CI] P Value Death 6.1% 4.6% 0.75 [0.56,1.00] 0.049 - Cardiac 4.2% 2.5% 0.59 [0.41,0.86] 0.005 - Non cardiac 2.0% 2.2% 1.10 [0.69,1.76] 0.69 Reinfarction 6.9% 5.1% 0.75 [0.56,0.98] 0.038 - Q-wave 3.4% 3.1% 0.92 [0.63,1.34] 0.67 - Non Q-wave 3.9% 2.2% 0.56 [0.37,0.83] 0.004 Death or reinfarction 12.0% 9.1% 0.75 [0.61,0.93] 0.007 Ischemic TVR 11.0% 12.7% 1.17 [0.96,1.42] 0.12 - Ischemic TLR 8.7% 10.2% 1.19 [0.95,1.49] 0.12 - Ischemic remote TVR 3.8