选择性醛固酮封锁需与瞬态或永久心脏的急性心肌梗死住院期间衰竭患者.pptVIP

Need for Selective Aldosterone Blockade for Patients with Transient or Persistent Heart Failure During Hospitalisation for AMI Professor C Richard CONTI University of Florida College of Medicine, Gainsville, Florida (USA) Hospital Events in NRMI AMI Patients AMI and HF Conclusions from NMRI CHF and AMI is a high risk situation Despite the high risk, these patients are less frequently treated with medications with proven mortality benefit or with primary reperfusion strategies None of these patients were treated with aldactone or eplerenone Prognosis after Myocardial Infarction GRACE: Impact of Heart Failure on Cumulative Mortality From ACS Aldosterone Stimulates Myocardial Fibrosis Myocardial Fibrosis in Hypertension and CHF: The Aldosterone Hypothesis Pathophysiologic Mechanisms of Aldosterone in Heart Failure AIRE: ACE Inhibition for Post-MILV Dysfunction CAPRICORN: Beta-blockade for Post-MI LV Dysfunction(Only Event-free for All-cause Mortality) VALIANT: ARB and/or ACEI Post MI EPHESUS: Study Design EPHESUS Co-Primary Endpoint:Total Mortality (Duration of Study) EPHESUS Co-Primary Endpoint:CV Mortality/CV Hospitalization (30 Days) EPHESUS Co-Primary Endpoint:CV Mortality/CV Hospitalization(Duration of Study) EPHESUS:Sudden Death From Cardiac Causes EPHESUS: Rates of Hyperkalemia and Hypokalemia ACC/AHA Guidelines for Management ofST-Elevation MI with LV Dysfunction and HF Aspirin Clopidogrel ?-Blocker ACE inhibitor Aldosterone antagonist Heparin (UFH or LMWH) GP IIb-IIIa inhibitor (if receiving PCI) Eplerenone: Post-MI Heart Failure Indication and Dosing Indicated to improve survival of stable patients with Left ventricular systolic dysfunction (LVEF ?40%) Clinical evidence of HF after acute MI Start at 25 mg qd and titrate in a single step to target dosage of 50 mg qd, preferably within 4 weeks, as tolerated No interactions with ACE inhibitors, ARBs, beta-blockers, diuretics, aspirin, statins, or reperfusion therapy May be administered with or w