医学常见的急性心肌梗死的药物溶栓及介入治疗.pptVIP

Procedural characteristics (n=46) Glycoprotein IIb/IIIa use, - no.(%) 7 ( 15.2 % ) Thrombectomy, - no.(%) 0 ( 0 % ) Coronary-artery bypass grafting, - no.(%) 0 ( 0 % ) Distal protection device, - no.(%) 0 ( 0 % ) Coronary stents, - no.(%) 45 ( 97.8 % ) Complications - no.(%) Minor dissection 1 ( 2.2 % ) No reflow 2 ( 4.3 % ) (PPCI 5-25%) Improved TIMI grade flow 48.5±32.1 37.9±25.6 p＝0.01 Improved CTFC Improved MBG 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) 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) Clinical outcomes at 30days after symptom onset (n=47) 1.5% ~ 8.1% Borgia1 et al. 1.0% - 4.9% 1.2% - 5.8% Take Home Message 溶栓与介入的选择4个条件：发病时间，可能的拖延时间，患者本身风险度，年龄与梗死部位 溶栓后可以PCI，不管是否溶成，及时转运至有条件的中心是必要的 溶栓药物必须是短效与纤溶特异性的 溶栓后PCI的时间3小时以上是必须的，但最好12-24h Thank you for your attention The guidelines discuss in detail the decision to take the time from first medical contact or first door to balloon number to 90 minutes. For the last decade the importance of time to treatment in PPCI has been debated. The next few studies support the argument “time does matter in PPCI”. * “The mortality benefit associated with primary percutaneous coronary intervention in ST-segment elevation myocardial infarction may be lost if door-to-balloon time is delayed by 1 hour as compared with fibrinolytic therapy door-to-needle time. Interventional cardiology laboratories endeavoring to achieve the benefits of primary percutaneous coronary intervention seen in randomized clinical trials should aim to match their short door-to-balloon times”. (pg. 824) Legend key (pg.825) Absolute risk reduction in 4- to 6-week mortality rates with primary PCI as a function of PCI-related time delay. Circle sizes reflect the sample size of the individual study. Values 0 represent benefit and va