TACTICS-TIMI研究课件.pptVIP

Cholesterol Lowering Post MI TIMI IIIB - One Year Results * TACTICS- TIMI 18 Treat Angina with AggrastatTM and Determine Cost of Therapy with an Invasive or Conservative Strategy Unstable Angina and Non-Q Wave MI Center of spectrum of acute coronary syndromes 2-2.5 million hospital admissions /year worldwide ASA, heparin, beta-blockers beneficial Tirofiban (AggrastatTM) dramatic benefit Invasive vs. Consvative strategy ???? Background Unstable angina and non-Q wave MI Center of spectrum of acute coronary syndromes 890,000 hospital admissions per year in U.S. ASA, heparin, beta-blockers beneficial Tirofiban (AggrastatTM) dramatic benefit Invasive vs. Consvative strategy ???? Background Initial Medical Management: ASA 160-325 mg daily for all patients with UA (except if ongoing major or life-threatening hemorrhage, recent GI bleed, or ASA hypersensitivity) IV Heparin for intermediate or high-risk UA (i.e., prior CAD, rest pain, ECG changes, or age 65) Beta-blockers for all patients in the absence of contraindications (e.g., bradycardia, hypotension, AV block, asthma, severe LV dysfunction with CHF or shock, signif. COPD) Recommendations AHCPR Unstable Angina Guideline Braunwald, E., et al. Circulation 1994;90:613-22. Initial Medical Management (con’t): Nitrates: Use for patients with ongoing ischemia and use IV for high-risk patients. Switch to oral when stable Calcium antagonists: May be used to control angina if already on beta-blocker and nitrates, or if unable to tolerate beta-blockers (e.g. severe COPD). Use heart-rate lowering Ca+ blocker. Avoid in CHF or low EF. No thrombolysis: Shown to increase subsequent MI in TIMI IIIB trial in patients with unstable angina Recommendations AHCPR Unstable Angina Guideline Braunwald, E., et al. Circulation 1994;90:613-22. 4S CARE Cholesterol lowering: Check lipids 24 hours, treat as needed. CARE trial indicates benefit for patients with LDL 125 mg/dl. Low Molecular We