ST段抬高心肌梗死疗证据.ppt

2021/3/17 * De Luca G,et al. J Am Coll Cardiol 2003;42:991-997 2021/3/17 * De Luca G,et al. J Am Coll Cardiol 2003;42:991-997 2021/3/17 * De Luca G,et al. Circulation 2004;109:1223-1225 2021/3/17 * 186-图 Nallamothu BK, et al.Am J Cardiol 2004;94:772-774 * * 随访时间单位：月 * * Earlier iteration of MA Relates estimated mortality w lytic therapy to absolute benefit w PCI The greater the mortality w lytics the greater the benefit w PCI ( SHOCK) Conversely as mort w lytic falls , the absolute mortality benefit w PCI decreases Equipoise at 2-3%-- Time delay associated w PCI does not confer a mort adv 2021/3/17 * Rescue PCI is Beneficial Rescue Ⅰand Ⅱ and other（9 CRTs,n＝1456） Ellis SG, et al. Am Heart J 2000; 139:1046-53 2021/3/17 * REACT trial Rescue PCI/repeat lysis or conservative Death at 6 Ms: 9% VS 18% Gershlick AH, et al. N Engl J Med 2005; 353:2758-2768 2021/3/17 * Gershlick AH, et al. N Engl J Med 2005; 353:2758-2768 2021/3/17 * Gershlick AH, et al. N Engl J Med 2005; 353:2758-2768 2021/3/17 * Schomig A, et al. J Am Coll Cardiol 2004;44:2073-2079 Stents Superior to Balloon Angioplasty 2021/3/17 * Schomig A, et al. J Am Coll Cardiol 2004;44:2073-2079 2021/3/17 * Emergency PCI in Cardiogenic shock Beneficial 特殊策略: 患者75yrs, 发病36小时, Shock18Hrs 应完全血运重建（非限于IRA）,否则行CABG 应使用IABP 病死率在 NSTEMI 并发 Shock 者,和 STEMI 者一样高 ＞75 yr 者,早期 PCI 预后比想象的好 56%可出院（病死率44%） 出院者1年存活率达75% Benchmark Counterpulsation Outcome Registry（n＝25136） 住院死亡率:药物:32.5％ PCI:18.8％ CABG:19.2％ 2021/3/17 * Webb JG, et al. J Am Coll Cardiol 2003;42:1380-1386 2021/3/17 * Webb JG, et al. J Am Coll Cardiol 2003;42:1380-1386 2021/3/17 * Hochman JS,et al. N Engl J Med 1999;341:625-634 2021/3/17 * Hochman J