【2018年最新整理】围术期他汀强化治疗病例.pptVIP

* 针对上面结果的发布，国际著名专家纷纷发表评论。 * 研究也证实阿托伐他汀强化治疗，早期获益显著 * NCEP也指出： 加拿大AMI治疗质量监测指标制定小组指出 入院后24小时内血脂检测结果已不是ACS的患者他汀治疗的前提，不论患者血脂水平如何都应立即启动他汀治疗 （CMAJ ? October 21, 2008; 179 (9)） * PCI术后围手术期心肌损伤是PCI常见并发症，心肌标志物水平升高患者比例最高可达40%。围手术期心肌梗死也是影响患者预后的重要因素。多个研究证实PCI术前负荷量他汀治疗可显著减少围手术期心梗，改善近期预后。 [1].Eur Heart J 2005;26:1494–8. [2] J Am Coll Cardiol 2003;42:1406–11. [3] J Am Coll Cardiol [4] J Am Coll Cardiol 1998;31:241–51. * * NAPLES II是今年ACC会议上新公布的研究，是一项前瞻性、随机…..旨在评价PCI术前负荷量阿托伐他汀对围绕手术期心肌梗死的影响。入选……………术后6hrs 12hrs检测心肌标志物，围手术期心肌梗死的判断标准是CKMB升高3倍 * 看一下结果：生化指标显示，安慰剂组有15.8%的患者在PCI术后CKMB升高超过3倍正常高限，阿托伐他汀组CKMB只有9.5%，P=0.014，差异显著，即与安慰剂相比，阿托伐他汀显著降低了PCI围手术期心梗的发生。 * Discussing the results of NAPLES II during the late-breaking clinical trials session, Dr Christopher Cannon (Brigham and Womens Hospital, Boston, MA) said that one of the surprises of the Pravastatin or Atorvastatin Evaluation and Infection Therapy (PROVE-IT) study was the early separation of event curves, as early as 14 days, which suggested that high-dose atorvastatin might be beneficial in ACS patients beyond LDL lowering. Later studies, including the most recent JUPITER analysis, have suggested that pleiotropic effects, specifically anti-inflammatory effects, are responsible for some of the drugs benefit. I think we have now seen a shift where this is probably ready for prime time in our practice, such that the early benefit observed in PROVE-IT, linked to the anti-inflammatory effects of statins, now is shifting into the cath lab, said Cannon. Were now talking about statin pretreatment as something that will possibly influence the outcomes of PCI. In practice, said Cannon, clinicians should start intensive statin therapy in acute coronary syndrome patients on hospital admission and potentially the night prior to the procedure in elective PCI. During a discussion of the results following the late-breaking clinical-trials session, others were more cautious and focused on the definition of periprocedural MI and whether these enzy