课件：ESC非S段抬高型急性冠脉综合征诊疗指南解读.ppt

四，关于早期介入治疗 侵入性策略 vs. 保守策略 Lancet 2005;366:914 0 2 3 4 保守治疗 20.0 % 介入治疗 16.6 % 随访时间 (年) 累计率 比值比（OR） 0.78 95% CI 0.61~0.99 P = 0.044 死亡、心肌梗死、因ACS再次住院 1 5 RITA-3 危险分层 需行紧急( 120 分钟 )血管造影/血运重建的高危特点 难治性心绞痛 （如：无 ST段异常的进展型心肌梗死） 强化抗心绞痛药物治疗仍反复发生心绞痛，伴有ST 段压低( 2 mm)或T波倒置较深 心力衰竭或血流动力学不稳定的临床症状（“休克”） 致命性心律失常（心室颤动或室性心动过速 ） 危险分层 2 - 需行早期( 72 小时 )血管造影/血运重建的高危特点 肌钙蛋白水平升高 ST 段或 T 波动态改变（ 0.5 mm ） （有或无症状） 糖尿病 肾功能减低 （ GFR 60 ml/min/1.73m2 ） LVEF 40% 心肌梗死后的早期心绞痛 PCI 后6个月内 曾行CABG 风险评分提示中度至高度风险 危险分层 3 - 不存在高危风险 无反复发作胸痛 无心力衰竭体征 初次或第二次ECG（ 6 ~ 12小时）未见异常 肌钙蛋白未见升高（就诊时，就诊后6 ~ 12小时） THANK YOU SUCCESS * * 可编辑 Several reports have shown that over time, the annual incidence of Q-wave infarction per 100,000 inhabitants was gradually declining, and that conversely, the frequency of non-Q wave infarction was increasing, with the rate now higher than for Q-wave MI. In addition, initial mortality in ST elevation MI is higher during the first month of evolution than in non-ST elevation MI. After hospital discharge, the rate of events is greater with non-ST elevation MI, with the result that the death rate at 1 year is equal in both clinical presentations of ACS. OAsis-5 was a non-inferiority trial comparing enoxaparin to fondaparinux a synthetic pentasaccharide, with an pure indirect anti Xa activity in non-ST elevation ACS. The primary endpoint was a composite of death, MI and refractory ischemia at 9 days. Fondaparinux was non-inferior to enoxaparin at 9 days. However, a nearly 50% risk reduction for bleeding was observed at 9 days. At 30 days and 6 months, a significant risk reduction of most endpoints was observed, especially death. Most of the risk reduction for death at 30 days and 6 months was linked to the risk reduction for bleeding. In this trial, as in many other reports, bleeding complications was shown to lead to a four- to five-fold increase in the risk of death, MI or stroke at 30 days and long-term. OAsis-5 was a non-inferiority trial comparing enoxaparin to fondaparinux a synt