非ST段抬高性急性冠脉综合的介入治疗.ppt

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1、非ST断抬高性急性冠脉综合的介入治疗广东省心血管病研究所陈纪言RITA-3-resultsinterventionconservativeRR(95%CI)pn=895n=9154-MonthD/MI/Angina86(9.6%)133(14.5%)0.66(0.51-0.85)0.0011-yearD/MI68(7.6%)76(8.3%)0.91(0.67-1.25)0.58Symptomsofanginawereimprovedanduseofantianginalmedicationsreducedwiththeinterventionalstrategy(p<0.

2、0001)FRISC-II2yearsfollow-upJACC2002.40:1902-14invasiveconservativeRR(95%CI)PMortality(%)3.75.40.68(0.47-0.98)0.038MI(%)9.212.70.72(0.57-0.91)0.005D/MI(%)12.116.30.74(0.61-0.09)0.003Afterthefirstyear,therewasnodifferenceinmortalitybetweenthetwogroups,fewerMIsininvasivegroup.NumberofD/MIsw

3、ithin1yearInvasiveConservativeRITA368/895(7.6%)76/915(8.3%)VINO4/64(6.3%)15/67(22.4%)TACTICS-TIMI1881/1114(7.3%)105/1106(9.5%)TRUCS6/76(7.6%)12/72(16.7%)FRISCII127/1219(10.4%)174/1234(14.1%)MATE11/111(9.9%)6/90(6.7%)VANQWISH111/462(24.0%)85/458(18.6%)TIMIIIIB52/484(10.8%)62/509(12.2%)Comb

4、inedriskratio0.88(95%CI0.78-0.99)0.10.51.02.010.0早期侵入治疗优于早期保守治疗这些试验比较些什么?早期介入治疗与早期保守治疗？早期介入策略与早期保守策略？非ST断抬高性急性冠脉综合的介入治疗是早期介入策略获益！非ST断抬高性急性冠脉综合的介入策略是早期介入策略获益！早期介入策略如何获益？UA&NSTEMIEarlyinvasivevs.earlyconservativestrategiesEarlyinvasive:Earlycoronaryarteriographyfollowedbyrevascularization

5、asindicatedbyarteriographicfindingsEarlyconservative:Catheterization,andifindicated,revascularization,onlyintheeventoffailureofmedicaltherapy6-monthMortalityforAcuteCoronarySyndromesT-waveinversionACSSTACSGrangerCBetal.JAmCollCardiol.1998;31:79A.%Cumulativemortalityat6monthsSTMIwithf

6、ibrinolytics2457patientswithACS(follow-up6months)EarlyInvasiveStrategies-FRISCⅡLancet1999,Vol35404’/05’:我们的策略是否有所改变？ICTUS研究对我们的启示ClassI:一、无严重合并症,合并以下高危因素,早期介入治疗:1抗缺血治疗中,反复休息时或轻微活动时胸痛/缺血2TnT或TnI升高3新出现ST段压低4反复胸痛/缺血,伴CHF症状,S3奔马律,肺水肿,MR5非创伤性负荷试验高危发现非ST段抬高性ACS早期介入干预时机-AHA/ACC指南（2002）ClassI:6LV

7、收缩功能降低(EF<0.4)7血流动力学不稳定8持续性室速96个月内PCI10CABG史二、无上述情况下，无再血管化禁忌症的住院病人，可选用早期介入或早期保守治疗（B）非ST段抬高性ACS早期介入干预时机-AHA/ACC指南（2002）ClinicalsuspicionofACSPhysicalexamination,EchocardiogramECGmonitoring,BloodsamplesNopersistentSegmentelevationGp2b/3aCor.AngiographyLowriskHighriskP