ACS是否应该早期介入治疗.pptVIP

Is early invasive the answer for ACS Dr. Ben He MD/PhD/FSCAI/FAPSIC Director of Cardiology Department Renji Hospital Affiliated to Shanghai Jiaotong university ACS is an Important Manifestation of Atherothrombosis1 Relation of TIMI risk score and MACE rate Hot topic in ACS Is early invasive superior to conservative strategy in ACS? Should invasive be deferred for cooling off? What is the optimal time for invasive? Optimal Strategy for UA/NSTEMI FRICS-II: high risk get more TIMI-18: high risk get more RITA-3: 13 yrs outcome RITA-3: 5yrs outcome In 2005,It seems we found answer In ACS, early invasive superior to early conservative This is particular true in high risk patients ESC Guideline 2005 Is the problem settled? ICTUS Designed ICTUS’s criticism Liberty definition of MI (only 1*ULN) causing the early MI increase in early invasive group 3yrs revascularization rate was equal in 2 group(81%PCI) 1year mortality rate in ACS in both arm are very low(2.5%),Is it a real high risk? Even put ICTUS into pool, Inv Cons Inv vs Cons/All cause death 2007 ESC Guideline Urgent Coronary angiography is recommended in Pts with refractory or recurrent angina associated with dynamic ST deviation, heart failure, life threatening arrhythmias, or haemodynamic instability (I-C) Early(72h) angiography followed by revascularization (PCI or CABG) in patients with intermediate to high risk features is recommended (I-A) ISAR-COOL Trial ISAR-COOL Antithrombotic Regimen ISAR-COOL What is the optimal time for PCI? Methods for Optimal trial Results of Optimal trial Conclusion from Optimal trial What’s the difference between ISAR-Cool Optimal? Time to Coronary Angiography and Outcomes Among Patients With High-Risk Non–ST-Segment–Elevation Acute Coronary Syndromes: Results From the SYNERGY Trial  Pierluigi Tricoci, MD, MHS, PhD; Yuliya Lokhnygina, PhD; Lisa G. Berdan, PA-C, MHS; Steven R. Steinhubl, MD; Dietrich C. Gulba, MD; Harvey D. White, MD; Neal S. Kleiman, MD; Philip E. Aylw