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1、《规范化介入治疗》这样的病例我们可以“不做”武汉亚洲心脏病医院朱国英冠心病药物治疗介入治疗外科手术冠心病的治疗策略危险因素血运重建可以做—适应证不可以做—禁忌证可以不做—权衡利弊BalloonAngioplastyStentsDrugElutingStents1977-19891990-20002001-可以做—适应证不可以做—禁忌证可以不做—权衡利弊CRFDESEvidence-basedMedicineGuidelinesSummary2007ⅠⅡaⅡbⅢAISRofBMSBCTOBifurcation(DESmainbranch,sidebranchPTCAw/prov
2、isionalDES)Multivessaldisease(Vs.CABG)(Pts.withmostlynoncomplexlesion)ISRwithbranchytherapyfailureBifurcation(planned2stent–eitherroutineT-stentofcrush(withfinalkiss)orSKS(V-stent)Multivessaldisease(Vs.CABG)(Pts.Withmultiplecomplexlesion,diffusedisease,especiallydiabetics)UnprotectedLMAMICD
3、ESforISRofDES(?sameordifferentDES)可以做——适应证不可以做——禁忌证可以不做——权衡“利弊”把握“分寸”OATTrial-StudyDesignPrimaryEndpoints:Death,MI,orNYHAclassIVheartfailurePCIwithstentingn=1082MedicalTherapyn=10842166patientswithangiographyonday3-28post-MIrevealingtotalocclusionoftheinfarct-relatedarterywithTIMIflowgrade0
4、or1;andmeetingacriterionforincreasedrisk,definedasEF<50%,proximalocclusionofamajorepicardialvesselwithalargeriskregion,orbothExclusions:NYHAclassIIIorIVheartfailure,shock,serumcreatinineconcentration>2.5mg/dl,angiographicallysignificantleftmainorthree-vesselcoronaryarterydisease,anginaatres
5、t,orsevereischemiaonstresstesting.Randomized.22%female,meanage59years,meanfollow-up3years,meanEF48%atbaselineConcomitantmedications:Aspirin,anticoagulationifindicated,ACEinhibitors,beta-blockers,andlipid-loweringtherapy,unlesscontraindicatedPresentedatAHA2006COURAGE:StudydesignBodenWEetal.A
6、mHeartJ.2006;151:1173-9.BodenWEetal.NEnglJMed.2007;356:1503-16.Optimalmedicaltherapy*+PCI(n=1149)Optimalmedicaltherapy (n=1138)AHA/ACCClassI/IIindicationsforPCI,suitablecoronaryarteryanatomy+ ≥70%stenosisin≥1proximalepicardialvessel+objectiveevidenceofischemia (or≥80%stenosis+CCSclassIIIang
7、inawithoutprovocationtesting)Primaryoutcomes:All-causemortality,nonfatalMIFollow-up:Median4.6yearsRandomized*Intensivepharmacologictherapy+lifestyleintervention CCS=CanadianCardiovascularSocietySecondaryoutcomes:Death,MI,stroke;ACShospitalization--如何决定完全
