心肌梗死的药物介入策略 上海交通大学仁济医院.ppt

Time intervals lysis 2.0h 1.1h 0.5h 1.5h 6.8h Median D-to-N time: 1.6h Median D-to-B time: 8.4h symptom onset hospitalization consent signature balloon infllation 2 with no lesions ≥50% diameter stenosis and 1 with unsuitable anatomy did not undergo PCI 35 had successful PCI but 2 failed 6 had TIMI 0-1 34 had TIMI 2-3 50 enrolled and accepted half-dose rt-PA 40(81.6%) Achieved clinical criteria of reperfusion 1 was unwilling to undergo angiography 9(18.4%) underwent rescue PCI 4 had TIMI 2-3 5 had TIMI 0-1 8 had successful PCI but 1 failed Early PCI 75.5% Clinical outcomes during initial hospitalization (n=49) Clinical outcomes at 30days after symptom onset (n=47) TMPFC: A novel method for myocardium perfusion assessment  Cath Cardiovasc Interv. 2010;75(5):722-32. (IF 2.4) Superior to MBG TMPG with easier low varibility Predict short-term prognosis Cath Cardiovasc Interv 2010;75:733-734 59.7±37.2 26.7±19.9 36.9±23.4 37.8±21.5 n=12 n=8 n=15 n=11 Optimal time of early PCI (Pilot) 137.5±57.3 110.8±51.3 116.7±52.5 157.0±44.8 n=12 n=8 n=4 n=14 Optimal time of early PCI (Pilot) It’s time to investigate whether reperfusion benefit transfer to clinical one? Conclusion from pilot Rt-PA 50mg reached 76% successful rate(=TIMI2) and is suitable for pharmacoinvasive PCI can be safely performed after rt-PA thrombolysis without increasing bleeding and other complications PCI after rt-PA will further increase epicardial as well as myocardial reperfusion. Although the time window of PCI after lytic still need further elucidated ,our primary results showing that 3-6 hrs is good for reperfusion,epicardial or myocardium. Perspective from pilot Whether epicardial and myocardial reperfusion benefit transfer to clinical endpoint benefit need further study. It’s time to further elucidate whether this pharmacoinvasive strategy is comparable with primary PCI. Larger scale of trial is going to start. Take Home Message 溶栓与介