急性心肌梗死后患者的规范化治疗.pptVIP

* * * * * In the Clopidogrel for the Reduction of Events during Observation (CREDO) trial, 2116 patients scheduled to undergo percutaneous coronary intervention (PCI) or thought to be at high likelihood of undergoing PCI were randomized to a 300mg loading dose of clopidogrel vs. placebo 3-24 hours prior to PCI. Following PCI, all patients received 75mg daily clopidogrel through day 28. From day 28 through 1 year, patients in the loading dose group received 75mg daily placebo. Clopidogrel reduced the 1-year risk of MI, stroke, or death by 27% (95% confidence interval [CI], 3.9%-44.4%; P =.02; absolute reduction, 3%). No significant difference was seen in 28 day combined risk of MI, death, or urgent target vessel revascularization (risk reduction, 18.5%; 95% CI, -14.2% to 41.8%; P =.23). * * * * * * * * * * * * * * Lipid-modifying therapies include HMG CoA reductase inhibitors (statins), fibrates, bile acid sequestrants (resins), nicotinic acid and its derivatives, and probucol. Statins are highly effective in lowering LDL-cholesterol and have a good tolerability profile.1-3 Data presented in this slide does not include rosuvastatin. Bile acid sequestrants are potent cholesterol-modifying agents. Adverse events such as gastrointestinal bloating, nausea and constipation limit compliance to the bile acid sequestrants.1,2 Nicotinic acid, a B-complex vitamin, is effective at reducing both LDL cholesterol and triglyceride concentrations, and increasing HDL cholesterol levels. To be effective, it must be given in pharmacologic doses. The value of nicotinic acid has been limited by the incidence of adverse events, which include flushing, skin problems, gastrointestinal distress, liver toxicity, hyperglycaemia and hyperuricemia.1,2 Fibrates are effective triglyceride-lowering and HDL-raising drugs. However, in the majority of patients they are only moderately successful in reducing LDL-cholesterol.1,2 Probucol is not available in most countries. It has only a modest L