老人左主干病变介入治疗策略和技巧吕树铮.pptxVIP

老人左主干病变介入治疗策略和技巧吕树铮第1页/共64页 Lefeng Wang MDHeart Center Beijing Chaoyang Hospital第2页/共64页 The Elderly: The Fastest Growing Population第3页/共64页 A Challenge for the FutureCoronary revascularization in the very elderly:-Many patients-Limited Data: No guideline Lack clinical evidence 第4页/共64页 CV Disease during Aging ProcessDriver. J.A et al. BMJ 2008;337 No.22,048 US Doctors with 23ys Follow up 第5页/共64页 Comorbidity in ACS Patients According to Age:Data from Crusade egistryCirculation 2007;115:2549-69第6页/共64页 第7页/共64页 Consecutive PCI 30-day MortalityN=22016Czch National PCI Registry 2006第8页/共64页 Strategies to Elderly PatientInterventions and operations for symptomatic indications.No interventions and operations for prognostictic indications.Patients often too sick, too many co-morbidities, too diffuse coronary artery disease for invasive procedure.Interventions and operations too expensive and long term benefit unclear. 第9页/共64页 ACC/AHA Guidelines for Management of NSTEMI : Class I Recommendations in Elderly PatientCirculation 2007;115:2549-69第10页/共64页 Swedish Registry on Cardiac Intensive Care(RiksHIA) Rate of Revascularization and Mortality in STEMI According to Age and Gender第11页/共64页 TACTICS-TIMI -18 TrialAm J CardIol 2003;91:1466第12页/共64页 Lancet 1999;354:708-15第13页/共64页 第14页/共64页 Long Term Benefit of Revascularization in Elderly Patients1 Circulation 2002;105:2378-842 Circulation 2004;7:1213-8第15页/共64页 Gain of Quality of Life with Revascularization in the Elderly第16页/共64页 第17页/共64页 第18页/共64页 第19页/共64页 第20页/共64页 第21页/共64页 第22页/共64页 Male, 88yrsNo hypertension,no diabites,no smokingAnterior AMIAs chest pain relieved and onset-door time was 15hrs, primary angiography was not taken 第23页/共64页 Angiography7days laterTransfemoral CAG failed because of occulusion of distal abdominal aortaTrans-right radial CAG sucessfully performed with severe calcification LM with triple vessel disease.Refered for CABG第24页/共64页 第25页/共64页 LCA第26页/共64页 RCA第27页/