沈珠军ACS诊治及进展沧州PPT课件.ppt

ACS诊治及其进展 ;提 纲;Acute Coronary Syndrome Unstable Inflammed Plaque Thrombosis plus plaque limiting Flow “ Active Volcano” ;;James Herrick 1912: First description of Coronary Thrombosis as cause of Acute Myocardial Infarct (AMI);Renthrop 1982: Demonstration of Coronary thrombus in patients with STEMI undergoing selective coronary angiography;急性心肌梗死诊断三要素;症 状;心电图: 非ST段抬高心肌缺梗死;Early Repolarization;AMI的血清心肌标记物及其检测时间;新型心肌酶标志物的检测;Translational Research 2012;159:252–264;Translational Research 2012;159:252–264;Cardiac troponin： Conventional cTn I and T High-sensitivity cTn ;European Heart Journal (2014) 35, 552–556;Copeptin（和肽素） the c-terminal part of the vasopressin prohormone quantify the individual endogenous stress level appears to be identified early after symptom onset ideal marker to compensate for the sensitivity deficit of conventional cTn assays in early presenters ;J Am Coll Cardiol 2013;62:150–60;J Am Coll Cardiol 2013;62:150–60;Heart type fatty acid binding protein（H-FABP） low molecular weight protein released early in myocardial infarction （before necrosis） reaching peak levels at 5–6 h returning to normal levels within 36 h higher content in cardiac cells lower plasma value of HFABP ;MiRNAs： Short non-coding RNA molecules involved in post-transcriptional gene regulation Cardiac miRNAs are markedly dysregulated in MI Levels of circulating miRNAs after AMI are induced by myocardial injury and parallel the extent of the myocardial damage measured by cTn levels;European Heart Journal (2010) 31, 659–666;STEMI;前壁心梗，LAD血栓;STEMI的时间延误情况;AMI24小时内院前及院内处理流程——ESC指南2012; Summary of 23 Randomized Trials (n=7739);Evidence to support Transfer to PCI Centers from Hospitals without PCI facilities for STEMI ACS;再灌注治疗策略推荐;院前溶栓 for Early ( 2 Hour) STEMI;STEMI的溶栓治疗;STEMI溶栓禁忌证;溶栓药物进展;溶栓药物比较;冠状动脉再通指征直接指征 (90min冠造);冠状动脉再通指征间接指征;Non-STEMI ACS;NSTEMI - PURSUIT SCORE;最为简单的TIMI评分;