高润霖冠心病介入治疗的热点.pptxVIP

高润霖冠心病介入治疗的热点; DES的安全性和长期疗效  新一代DES;From TCT 2006;From TCT 2006;;;;;;ARC Proposed Standard Definitions;Stent Thrombosis: FDA Advisory Panel, 8RCT;When DES are used for their approved indications, the risk of thrombosis does not outweigh their advantages over BMS in reducing TLR As compared with on-label use, off-label use is associated with increased risks of both early and late stent thrombosis,as well as death or MI;第13页/共82页;第14页/共82页;第15页/共82页;第16页/共82页;第17页/共82页;第18页/共82页;第19页/共82页;第20页/共82页;第21页/共82页;第22页/共82页;第23页/共82页;第24页/共82页; RCT荟萃分析显示,死亡、MI,不论on-label或off-label应用,在DES与BMS组均无显著差别;TVR则不论on-label或off-label应用 DES均明显低于BMS 30 项研究 174,302患者真实世界注册研究则显示,全因死亡、MI在DES组均明显低于BMS DES的长期安全性及有效性已得到临床试验及真实世界研究证实;;;A 65-year old male with CAD, hypertension, MI, Status post x2 stents, RCA, proximal BxVelocity and Cypher distal - 15 months prior to death (traumatic brain injury) ;Discontinuation of Anti-platelet Therapy and Risk for ST;双重抗血小板治疗至少一年 不适宜DES置入的情况 计划中的非心脏手术 不适宜长期双重抗血小板治疗 置入DES后必须行非心脏手术者 尽量不停阿斯匹林 术后尽早恢复氯吡格雷治疗 教育病人家属，与相关医师沟通、必要时咨询心脏科医生;不适宜长期双重抗血小板治疗的情况;Summary;;第34页/共82页;第35页/共82页;第36页/共82页;第37页/共82页;第38页/共82页;第39页/共82页;第40页/共82页;第41页/共82页;第42页/共82页;第43页/共82页;第44页/共82页;010300jt-os.ppt - On-screen 45;Acute Myocardial Infarction;TAPAS Trial: 1071 STEMI patients randomized; TAPAS Primary endpoint Myocardial blush grade;TAPAS: Mortality at 1 year;TAPAS: Mortality or non-fatal ReMI at 1 year;Take Home Message;在稳定性CAD患者中，哪些患者更能从PCI获益;AMI: Pathophysiology;;ACS: Pathophysiology;;;Stable Coronary Artery Disease;COURAGE: Study design;;COURAGE: Treatment effect on primary outcome;No. at risk;COURAGE: Treatment effect on hospitalization for ACS;COURAGE: Treatment effect on angina;Boden WE et al. N Engl J Med. 2007;356:1503-16.;PCI + OMT compared to OMT resulted in: Significantly less use of nitrates at - 1 year (53% vs. 67%) - 3 years (47% vs. 61%) - 5 years (40% vs. 57%) Significantly less use of Ca+2 channel blockers at - 1 year