ACS患者他汀处理办法.pptVIP

* 4 The inciting event in an acute coronary syndrome is generally rupture of a lipid rich atherosclerotic plaque. Platelets adhere and aggregate via fibrinogen cross-linking at the Glycoprotein 2b/3a receptor. The coagulation cascade is initiated on the platelet surface and downstream from the thrombus ishcemia and necrosis occur. Many novel therapies have been introduced in the past few years to treat the platelet and thrombin aspects of this schema. The focus of the PROVE IT trial is on stabilization of the culprit lesion, improving endothelial functioning and potentially decreasing vascular inflammation. * Observational data suggest that lipid-lowering therapy after ACS reduces the risk of short-term mortality, maybe by as much as a third. Aronow used data from the GUSTO IIb and PURSUIT trials in ACS, dividing hospital survivors into 2 groups; those who received lipid-lowering agents at discharge (n=3653) and those who did not (n=17156). They observed that 6-month all-cause mortality occurred in 63 (1.7%) of those discharged with lipid-lowering therapy compared to 605 (3.5%) of those discharged without [hazard ratio 0.49 (0.37-0.63 CI); p0.0001]. After applying the propensity analysis * and covariates the lower mortality was still found to be significant [hazard ratio 0.67 (0.48-0.95 CI); p=0.023]. Of note, this difference in outcomes was seen very early (beginning within 1 month) post-ACS. * Patients in the original 2 studies were not randomized to treatment with lipid-lowering agents but propensity analysis was used to account for the confounding factors involved in choosing lipid-lowering therapy without randomization. Lipid-lowering agents were not limited to statins in the analysis. * 近来的一些小规模研究观察了急性冠脉综合征（ ACS ）后早期开始应用他汀治疗的作用。 PTT,L-CAD和RECIFE都是研究普伐他汀的作用，尽管所有这些研究都是小规模的，每一项研究均表明早期开始应用普伐他汀治疗是有益的。 FLORIDA是一项双盲、安慰剂对照试验，在急性心肌梗塞（ AMI ）症状出现后平均8天时开始应用氟伐他汀。主要研究终点是各种临床事件（心血管死亡，非心血管死亡，再发心肌梗塞，再发心肌缺血而住院，CABG 或PCTA）及1年时48小时监测心肌缺血。氟伐他汀治疗并未发现显著临床益处。