急性冠脉综合征患者冠脉介入治疗指南英文.pptxVIP

急性冠脉综合征患者冠脉介入治疗指南英文 ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction第2页/共73页 第3页/共73页 Hospitalizations in the U.S. Due to ACSAcute Coronary Syndromes*1.57 Million Hospital Admissions - ACSUA/NSTEMI?STEMI1.24 million Admissions per year0.33 million Admissions per year*Primary and secondary diagnoses. ?About 0.57 million NSTEMI and 0.67 million UA.Heart Disease and Stroke Statistics – 2007 Update. Circulation 2007; 115:69–171.第4页/共73页 第5页/共73页 第6页/共73页 第7页/共73页 Primary PCI for STEMISTEMI patients presenting to a hospital with PCI capability should be treated with primary PCI within 90 min of first medical contact as a systems goal. STEMI patients presenting to a hospital without PCI capability, and who cannot be transferred to a PCI center and undergo PCI within 90 min of first medical contact, should be treated with fibrinolytic therapy within 30 min of hospital presentation as a systems goal, unless fibrinolytic therapy is contraindicated.IIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIAIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIB第8页/共73页  A strategy of coronary angiography with intent toperform PCI (or emergency CABG) isrecommended in patients who have receivedfibrinolytic therapy and have:Cardiogenic shock in patients 75 years who are suitable candidates for revascularizationb. Severe congestive heart failure and/or pulmonary edema (Killip class III)c. Hemodynamically compromising ventricular arrhythmias.IIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIcIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIBIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIBRe