pci波立维 ppt课件知识讲稿.ppt

* CLARITY研究的亚组分析PCI-CLARITY还显示出，对于STEMI溶栓治疗之后择期接受PCI的患者，两联抗血小板治疗的益处在接受PCI之前即已显示出来。 Prior to undergoing PCI, treatment with clopidogrel significantly reduced the rate of recurrent myocardial infarction or stroke by 38% (4.0% vs. 6.2%, adjusted OR 0.62, 95% CI 0.40-0.95, P=.028). Sabatine M, et al. JAMA 2005, in press. * Looking at the per protocol population of those patients who underwent a PCI, pretreatment with a 300mg loading dose of 波立维 led to an 18.5% relative reduction in the risk of 死亡, MI, and urgent target vessel revascularization at 28 days that did not achieve statistical significance (95% CI, 14.2 – 41.8, p=0.23).1 The relative risk reduction for the per protocol endpoints (MI, 死亡, TVR or MI, 死亡) also showed similar risk reductions. The results observed in the early phase were consistent with those of other trials in the area: EPISTENT, TARGET, PCI-CURE. In CREDO, good standard of care in the overall study population led to a lower than expected overall event rate in the trial (8.3% actual vs 13.4% planned) which may have contributed to the observed results. The time to PCI in the CREDO trial was much shorter than in previous trials in patients undergoing PCI (mean: 9.8 hours). For example, in the PCI-CURE2 trial, the mean time between randomization and PCI was 10 days. References: Steinhubl SR, Berger PB, Tift Mann III J, et al. JAMA, November 20, 2002 – Vol 288, No 19: 2411 – 2420. Mehta SR et al. Lancet. 2001: 358: 527–33. * 冠脉支架植入术后推延给予氯吡格雷与30天内心血管不良事件的发生具有相关性。 使用魁北克省的给药数据库，作者研究了1999年至2000年的出院带药患者，他们在PCI支架植入术后5天内出院。 研究挑选1999年1月至200年11月接受冠脉支架植入术，并在术后5天内接受氯吡格雷的患者。追踪病人直至30天或者出现首次不良事件。 2927名PCI后服用氯吡格雷的患者加入该项研究队列。推延使用氯吡格雷（ OR 1.77, 95% CI 1.16-2.70 ）伴风险较高。性别、以前因不稳定型心绞痛或心肌梗死入院、使用阿司匹林或目标手术6个月前血运重建病史（PCI或冠脉搭桥）与不良事件均无统计学相关性。 Brophy et al. Am Heart J 2006; 152:263-9 * NSTE ACS患者在PCI前接受600mg氯吡格雷负荷剂量较300mg剂量可以在围手术期间更好地抑制血小板功能，减少缺血事件复发。 共292名接受冠脉支架植入术的NSTE ACS连续患者在经皮冠脉介入术前至少12小时接受300mg（n＝146）或600mg（n＝146）负荷剂量氯吡格雷。在经皮冠脉介入术前服药后取单个血样，分析ADP介导的血小板聚集的最大