该不该处理 STEMI患者的非“罪犯”病变.ppt

MACE All-cause Mortality Repeat Revascularisation Repeat Myocardial Infarction Cardiovascular Mortality 指南更新 欧洲重建指南2014 欧洲重建指南2014：STEMI 实践 50-70% 70-90% 90% Immediate PCI Staged PCI Medical therapy Immediate PCI Immediate PCI Staged PCI Staged PCI Medical therapy Medical therapy Management of Non-Culprit Lesions Identified at the time of Primary PCI Preventive PCI No Preventive PCI Increase Procedure time (minutes) 63 45 40% Procedure time and radiation Radiation dose (Gycm2) 90 71 27% 理解指南 可以 ≠ 必须 It remains to be determined how clinicians can identify lesions that should be revascularized beyond the culprit lesion and whether complete revascularization should be performed in single- or multi-stage procedures. At present, multivessel PCI during STEMI should be considered in patients with cardiogenic shock in the presence of multiple, critical stenoses or highly unstable lesions (angiographic signs of possible thrombus or lesion disruption), and if there is persistent ischaemia after PCI on the supposed culprit lesion. ESC guideline 2014 小结 PCI完全重建显示获益 STEMI患者亦然 重建时机值得讨论 新的证据支持直接PCI时完全重建 应考虑患者耐受和治疗条件 谢谢！ In patients with multivessel disease who underwent percutaneous coronary intervention (PCI) during the era of first-generation drug-eluting stents (DES), incomplete revascularization heightened the risk of mortality at 5 years, according to a study published online June 4, 2013, ahead of print in the?American Journal of Cardiology. Edward L. Hannan, PhD, of the University at Albany, State University of New York (Albany, NY), and colleagues conducted a database analysis using the Percutaneous Coronary Intervention Reporting System of New York State and the Cardiac Surgery Reporting System to identify 21,767 patients with multivessel disease who underwent stenting from October 2003 to December 2005. The investigators also used the National Center for Health Statistics National Death Index to track all-cause mortality over a median of 3.9 years. Complete revasc