艾卡特在急性冠脉综合症中的应用.ppt

* This chart breaks the results down to the individual endpoint components and major adverse cardiac endpoints (MACE). There was a significant reduction in MACE with HDB tirofiban, and a reduction in MI which trended toward significant. * It was indicated that ADVANCE included pre-specified high-risk subgroup analyses (diabetes and ACS). Results of these analyses confirmed the significant benefit gained by high-risk as compared to low-risk patients. There were no cases of major bleeding, transfusion, or severe thrombocytopenia in ADVANCE. With respect to minor bleeding, the difference between the treatment groups was not significant. * * The significant reductions in markers of cardiac ischemia (troponin and CK-MB) seen with HDB tirofiban post-PCI indicates that HDB tirofiban was able to reduce the incidence of peri-procedural myocardial ischemia. * * * The photograph on the left shows complete thrombotic occlusion of a coronary artery, which manifests clinically as a STEMI. The completely occlusive thrombus consists of a platelet-rich core (formed by platelet aggregation) and a superimposed network, or mesh, of cross-linked fibrin molecules (formed by activity of the coagulation cascade) and entrapped red blood cells. On the right, the drawing of a clot shows a fibrin mesh formed by bonds between activated platelets and fibrinogen. Trapped inside are red blood cells. In STEMI patients, 90% of the culprit vessel is occluded by the thrombus. 何为ON-TIME2研究？ON-TIME这一组研究都是关于替罗非班用于ST段抬高心梗患者的研究。ON-TIME1表明低剂量替罗非班在急性心梗中的应用未带来显著获益。这个低剂量是说明书的剂量。很多其他研究发现这个剂量可能太低了。因此，我们在ON-TIME 2研究中采用一个高剂量，大约高2.5倍。且这个高剂量倍后续进行的ON-TIME2随机研究延续使用。以下就是我要介绍给你们的这个研究。 * On-TIME 2 was the first study to determine the benefits of pre-hospital administration of HDB tirofiban in addition to dual antiplatelet therapy with aspirin and clopidogrel, in patients with STEMI. Treatment was initiated in the ambulance or referral center. All patients received aspirin and high-dose clopidogrel.