心肌梗死的药物介入策略历史,现状与展望.ppt

溶栓后PCI获益 溶栓后PCI Meta-2011 30d 复合终点 溶栓后PCI Meta-2011 30d缺血终点 30d出血终点 30d死亡率 溶栓后PCI 应该如何进行? Background :Current ESC Guideline 尚待回答的问题 Is routine PCI after TT safe? (bleeding? Ischemia?)---ASSENT4 Are all lytic agent suitable for TT in this strategy? When is the suitable or optimal time of PCI after TT Pharmacoinvasive therapy for ST elevation myocardial infarction in China: a pilot study   2 with no lesions ≥50% diameter stenosis and 1 with unsuitable anatomy did not undergo PCI 35 had successful PCI but 2 failed 6 had TIMI 0-1 34 had TIMI 2-3 50 enrolled and accepted half-dose rt-PA 40(81.6%) Achieved clinical criteria of reperfusion 1 was unwilling to undergo angiography 9(18.4%) underwent rescue PCI 4 had TIMI 2-3 5 had TIMI 0-1 8 had successful PCI but 1 failed Early PCI 75.5% Time intervals lysis 2.0h 1.1h 0.5h 1.5h 6.8h Median D-to-N time: 1.6h Median D-to-B time: 8.4h symptom onset hospitalization consent signature balloon infllation Clinical outcomes during initial hospitalization (n=49) Clinical outcomes at 30days after symptom onset (n=47) 59.7±37.2 26.7±19.9 36.9±23.4 37.8±21.5 n=12 n=8 n=15 n=11 Optimal time of early PCI (Pilot) TMPFC: A novel method for myocardium perfusion assessment  Cath Cardiovasc Interv. 2010;75(5):722-32. (IF 2.4) Superior to MBG TMPG with easier low varibility Predict short-term prognosis Cath Cardiovasc Interv 2010;75:733-734 137.5±57.3 110.8±51.3 116.7±52.5 157.0±44.8 n=12 n=8 n=4 n=14 Optimal time of early PCI (Pilot) It’s time to investigate whether reperfusion benefit transfer to clinical one? Conclusion from pilot Rt-PA 50mg reached 76% successful rate(=TIMI2) and is suitable for pharmacoinvasive PCI can be safely performed after rt-PA thrombolysis without increasing bleeding and other complications PCI after rt-PA will further increase epicardial as well as myocardial reperfusion. Although the time window of PCI after lytic still