ACS是否应该早期介入治疗.pptxVIP

ACS是否应该早期介入治疗第1页/共60页 ACS is an Important Manifestation of Atherothrombosis11. Cannon CP. J Thromb Thrombolysis 1995; 2: 205–218.AntithrombotictherapyStable anginaUANon-Q-wave MIThrombolysisprimary PCIQ-wave MIMinutes– hoursDays–weeksSTEMIUA/NSTEMIAtherothrombosisNew termOld termPlaquerupture第2页/共60页 第3页/共60页 Relation of TIMI risk score and MACE rate第4页/共60页 Hot topic in ACSIs early invasive superior to conservative strategy in ACS?Should invasive be deferred for cooling off? What is the optimal time for invasive?第5页/共60页 第6页/共60页 Optimal Strategy for UA/NSTEMITIMI IIIB2005ConservativeInvasiveVANQWISHFRISC IITACTICS-TIMI 18RITA-3第7页/共60页 FRICS-II: high risk get more第8页/共60页 TIMI-18: high risk get more第9页/共60页 RITA-3: 13 yrs outcome第10页/共60页 RITA-3: 5yrs outcome第11页/共60页 第12页/共60页 第13页/共60页 第14页/共60页 In 2005,It seems we found answerIn ACS, early invasive superior to early conservativeThis is particular true in high risk patients第15页/共60页 ESC Guideline 2005第16页/共60页 第17页/共60页 Is the problem settled?第18页/共60页 ICTUS Designed第19页/共60页 第20页/共60页 第21页/共60页 第22页/共60页 第23页/共60页 第24页/共60页 第25页/共60页 4 yrs ICTUS Lancet 2007;369:827-835However, most of selective pts were performed PCISo, the long-term f/u results do not inflect Inv/Cons strategy 第26页/共60页 4 yrs ICTUS Lancet 2007;369:827-835第27页/共60页 ICTUS’s criticism Liberty definition of MI (only 1*ULN) causing the early MI increase in early invasive group3yrs revascularization rate was equal in 2 group(81%PCI)1year mortality rate in ACS in both arm are very low(2.5%),Is it a real high risk?第28页/共60页 Even put ICTUS into pool, Inv Cons第29页/共60页 Inv vs Cons/All cause death High risk?第30页/共60页 第31页/共60页 第32页/共60页 2007 ESC GuidelineUrgent Coronary angiography is recommended in Pts with refractory or recurrent angina associated with dynamic ST deviation, heart failure, life threatening arrhythmias, or haemodynamic instability (I-C)Early(72h) angiography followed by revascularization (PCI or CABG) in patients with in