复杂的亚组患者中的血运重建术葛均波（英文版）.ppt

Survival Post PCI in EVENT Registry J Am Coll Cardiol Intv2009;2:37-45 Survival After Revascularization in CKDAlberta Provincial Project for Outcomes in CHD (APPROACH) Circulation 2004;110:1890-95 Nondialysis CKD Dialysis-CKD Survival Post CABG in ESRD J Am Coll Cardiol 2004;44:1343-1353 Algorithm For Revascularization in CKDA Nephrologists Perspective Clin J Am Soc Nephrol 2006;1:209-220 Conclusion The CKD patient represents a challenging patient population to treat with revascularization Has unique physiology predisposing both to the development of CAD and complications of revascularization therapies No recent randomized trial experience to guide selection of therapy Data seems to support the use of PCI (DES BMS) in patients with mild to moderate CKD Surgical revascularization may be best in those with ESRD Revascularization in poor LV function Jeroen J Bax Dept Cardiology Leiden University Medical Center The Netherlands ACC 2009, Orlando Grants: GE healthcare, BMS medical imaging, Edwards Lifesciences, Biotronik, St Jude Medical, Boston Scientific, Medtronic Ischemic LV Dysfunction Clinical goal: -identify patients with viable tissue -with potential to recover function -to justify enhanced surgical risk How to assess viability? Metabolism (glucose, FFA’s): FDG, BMIPP Intact cellmembrane: Tl-201 Intact mitochondria: Tc-99m Intact perfusion: Tl-201, Tc-99m, MCE Contractile reserve: stress echo / MRI Conclusions Revascularization in low EF has enhanced risk Assessment of viability is important But also: Scar extent LV size and function Mitral regurgitation Significantly Improved Vascular Complications Among Women Undergoing PCI:From the Northern New England PCI Registry Bina Ahmed*, Winthrop D. Piper, David Malenka, Peter VerLee, John Robb, Merle Kellet, Thomas Ryan, Michael Herne, William Phillips and Harold L. Dauerman* *University of Vermont College of Medicine Vascular Complications Decreasing After PCI:Is This Tr