acs治疗原则-精品ppt课件

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1、TheManagementofAcuteMyocardialInfarction北京协和医院急诊科朱华栋EarlyRepolarizationBrugadaSyndromeAnteriorAMIPrinzmetalAnginaPericarditisAcuteInf.AMISTSegmentElevation(Transmuralischemia)Non-infarctSTElevationSTSegmentDepression(Non-transmuralischemia)STDepressionNS

2、TEMITwaveinversionNSTEMINSTEACS:KeyThemesNSTEACS:ahighriskpopulationpatientriskbenefitfromtreatmentwithmedications,aninvasivestrategyInteractionbetweeninvasivestrategyandpharmacologictxAntithromboticscornerstoneoftreatmentAnticoagulants:heparin,LMWH,d

3、irectthrombininhibitorsAntiplateletagents:aspirin,IIb/IIIa,ADPinhibitorsAntmanEMetalNEnglJMed1996;335:1342-9Invasivevs.ConservativeStrategyforACSDeathor(re)-MITrialNPCIConsRITA318107.68.3VINO1316.322.4TACTICS22207.39.5TRUCS1487.616.7FRISCII245110.414.1MA

4、TE2019.96.7VANQUISH92024.012.2Overall7876Fox,Lancet360:743‘03Death/(re)InfarctionRR=0.88,p=0.05Interventionbetter0.10.20.30.50.71.01.52.0Death/(re)-MICP971744-45%ConsInvTACTICS–TIMI18TnTcutpoint=0.01ng/mL(54%ofptTnT+)TroponinT:Death,MI,RehospACS,6MonthsO

5、R=0.52*P<0.001InteractionP<0.001P=NS*n=414n=396n=463n=495BenefitsofanInvasiveStrategyinNon-STElevationACSOnlyshowntoreducedeathandMIinhighriskptsReducesre-hospitalization,anginainmanyothersShortenshospitalization,maybecosteffectiveWhatabouttheoptimaltimi

6、ngofaninvasivestrategy?MedicalTxfor72-170hrThen,cathlabn=207Cathlab6hrn=203ISAR-COOLCP1107655-4NeumannFJetalJAMA200467%hadtroponin,65%hadSTdepressionAspirin500mg,100mgbidClopidogrel600mg,75mgbidTirofiban10mg/kgbolus,0.10mg/kg/mininfusionHeparin(PTT60-8

7、5seconds)Non-STAcuteCoronarySyndrometroponinorSTdepressionn=410ISAR-COOLPrimaryEndpointCP1107655-230-dayeventrate(%)Death&MIDeathNeumannFJetalJAMA2004P=0.04P=0.23P=0.12P=0.56AnynonfatalMINonfatalQ-waveMIRR1.96(1.01-3.82)Coolingoff(n=207)Earlyinterventi

8、on(n=203)TimingofanInvasiveStrategyinNon-STElevationACSISAR-REACTwasasmall,singlecenterstudy.Clinicaltrialsarestillgoingon.Otheranalysesalsoindicatethatcathwithin24hoursisbetterthanlatercathOughttouseintensiveantiplatelett