PCI在2008年进展中的亮点PPT.ppt

Interventions for STEMI TRANSFER-AMITrial of Routine ANgioplasty and Stenting after Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction Objective: Determine the efficacy and safety of routine PCI within 6 hours of fibrinolysis among high risk STEMI patients presenting to non-PCI facilities Background: The ASSENT-4 trial showed that STEMI patients treated with early facilitated PCI experienced more major adverse events than PCI alone PCI Centre Cath Lab Community Hospital ED Cath/PCI within 6 hrs regardless of reperfusion status Cath and Rescue PCI ? GP IIb/IIIa Inhibitor TNK + ASA + Heparin or Enoxaparin + Clopidogrel Pharmacoinvasive Strategy Assess chest pain, ST? resolution 60-90 minutes after randomization High Risk ST Elevation MI within 12 hours of symptom onset Failed Reperfusion Successful Reperfusion Elective Cath ? PCI 24 hrs later Standard Treatment Repatriation of stable patients within 24 hrs of PCI Randomization Cantor et al, ACC/i2 2008 Urgent Transfer to PCI Centre Treatment Medical Therapies TNK Heparin or Enoxaparin in pts ≤ 75 yrs of age ASA 160-325 mg Clopidogrel 300mg bolus (75 mg if 75 years of age) All other meds as per ACC/AHA STEMI guidelines PCI PCI of culprit lesion if ≥ 70% stenosis or 50-70% stenosis with high-risk features (thrombus, ulceration, spontaneous dissection) Stents used whenever technically possible GP IIb/IIIa inhibitors left to operator’s discretion Cantor et al, ACC/i2 2008 0 2 4 6 8 10 12 14 16 18 0 5 10 15 20 25 30 10.6 16.6 Days from Randomization % of Patients Standard (n=496) Pharmacoinvasive (n=508) n=496 n=508 422 468 415 466 415 463 414 461 414 460 412 457 OR=0.537 (0.368, 0.783); p=0.0013 Primary Endpoint: 30-day combined death, re-MI, CHF, severe recurrent ischemia, shock Cantor et al, ACC/i2 2008 Components of Primary Endpoint Death Reinfarction Recurrent Ischemia New/worsening CHF Cardiogenic Shock Death/MI/Ischemia Standard Treatment (n=498) 3.6 6.0 2.2 5.2 2.6 11.7 Phar