ncep和ahaacc指南新证据.pptVIP

Replication of CHAMP Results Pearson RR et al. J Am Coll Cardiol 2002;39:452A. | Merenich JA et al. Am J Cardiol 2000;85:36A-42A. | McCarthy M. Lancet 2001;358:1618. | Mehta RH et al. JAMA 2002;287:1269-1276. Inter-Mountain Health Care Percent of Patients Aspirin 10 hospitals, n=43,841 B-Blocker ACEI Statin Rocky Mountain Kaiser Percent of Patients Aspirin 9 hospitals, n=1,716 B-Blocker ACEI Statin * * * * * * * * AHA GWTG–New England Percent of Patients Aspirin 24 hospitals, n=1,709 B-Blocker ACEI Statin ACC GAP–Michigan Percent of Patients Aspirin 10 hospitals, n=1,649 B-Blocker ACEI Statin * * * Pre (1996–97) Post (1998–99) Pre (1996–98) Post (1999–2000) Pre (1999) Post (2000) Pre (1998–99) Post (2000) In-Hospital Lipid-Lowering Therapy is Associated with Markedly Lower Mortality in Patients with ACS: OPUS-TIMI 16 Cannon CP et al. J Am Coll Cardiol 2001;35:334A. Reprinted with permission from the American College of Cardiology Foundation. Mortality by Statin Treatment, % 0 Postadmission Days 100 200 300 400 P0.0001 42% RiskReduction No Lipid Rx In-Hospital Lipid Rx 10% 90% No Lipid Rx(n=6405[62%]) Lipid Rx(n=3883[38%]) 10-Month Compliance Rate Studies of the Potential Early Benefits of Statins in Acute Coronary Syndromes Strenestrand U et al. JAMA 2001;285:430-436. | Heeschen C et al. Circulation 2002;105:1446-1452. | Cannon CP et al. J Am Coll Cardiol 2001;35:334A. | Aronow HD et al. Lancet 2001;357:1063-1068. Study Patients Statin Rx Analysis Observation Swedish 19,599 28% Propensity 1-year OR 0.75,P=0.001 OPUS-TIMI 16 10,288 38% Multivariate 1-year OR 0.58,P0.0001 PRISM-Plus 1,616 23% Multivariate 30-day OR 0.49,P=0.004 PURSUIT/GUSTO II 20,809 18% Propensity 6-month OR 0.67,P=0.023 Therapy more likely to be initiated by physician Therapy more likely to be continued by physician long term Patients less likely to be concerned about side effects/monitoring Patients more likely to view therapy as essential (heart medication) Patients more likel