2007ESC非ST段抬高型急性冠脉综合征诊疗指南解读演示幻灯片.pptVIP

危险分层 2 - 需行早期( 72 小时 )血管造影/血运重建的高危特点 肌钙蛋白水平升高 ST 段或 T 波动态改变（ 0.5 mm ） （有或无症状） 糖尿病 肾功能减低 （ GFR 60 ml/min/1.73m2 ） LVEF 40% 心肌梗死后的早期心绞痛 PCI 后6个月内 曾行CABG 风险评分提示中度至高度风险 危险分层 3 - 不存在高危风险 无反复发作胸痛 无心力衰竭体征 初次或第二次ECG（ 6 ~ 12小时）未见异常 肌钙蛋白未见升高（就诊时，就诊后6 ~ 12小时） Several reports have shown that over time, the annual incidence of Q-wave infarction per 100,000 inhabitants was gradually declining, and that conversely, the frequency of non-Q wave infarction was increasing, with the rate now higher than for Q-wave MI. In addition, initial mortality in ST elevation MI is higher during the first month of evolution than in non-ST elevation MI. After hospital discharge, the rate of events is greater with non-ST elevation MI, with the result that the death rate at 1 year is equal in both clinical presentations of ACS. OAsis-5 was a non-inferiority trial comparing enoxaparin to fondaparinux a synthetic pentasaccharide, with an pure indirect anti Xa activity in non-ST elevation ACS. The primary endpoint was a composite of death, MI and refractory ischemia at 9 days. Fondaparinux was non-inferior to enoxaparin at 9 days. However, a nearly 50% risk reduction for bleeding was observed at 9 days. At 30 days and 6 months, a significant risk reduction of most endpoints was observed, especially death. Most of the risk reduction for death at 30 days and 6 months was linked to the risk reduction for bleeding. In this trial, as in many other reports, bleeding complications was shown to lead to a four- to five-fold increase in the risk of death, MI or stroke at 30 days and long-term. OAsis-5 was a non-inferiority trial comparing enoxaparin to fondaparinux a synthetic pentasaccharide, with an pure indirect anti Xa activity in non-ST elevation ACS. The primary endpoint was a composite of death, MI and refractory ischemia at 9 days. Fondaparinux was non-inferior to enoxaparin at 9 days. However, a nearly 50% risk reduction for bleeding was observed at 9 days. At 30 days and 6 months, a significant r