急诊pci的若干问题

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1、急诊PCI的若干问题Endothelialprogenitorcell(EPC)capturingstentsHighdoseGPIIb/IIIainhibitorspre-hospitalizationManualthrombusaspiration(TA)duringPPCIPredictorsofstentthrombosisafterPPCI急诊PCI的若干问题Randomization50GenousTM50CrCo6-monthclinical,angio&IVUSFUGENIUS-STEMITrial2007.8-

2、9,SinglecenterprospectiveASA100mg/day+clopidogrel75mg/day30daysGPIIb/IIIainhibitorsandthromboaspirationatthediscretionofthephysicianPresentedbyDr.PavelCervinkaatACC.09/i2,Orlando,FLGENIUS-STEMITrial6-monthclinicaloutcomeMACECVDeathsMITLRSTP=0.03P=NSP=0.04P=NSP=NSGeno

3、usTMCrCo2410PresentedbyDr.PavelCervinkaatACC.09/i2,Orlando,FLGENIUS-STEMITrialConclusionsTheuseofEPCcapturestentsinthesettingofSTEMIisfeasible&safe.RateofMACEat6-monthFUwassignificantlyhigherinGenousTMgroupthanCrCostents.WarrisomeistherateoflatestentthrombosisinEPCsc

4、apturestentgroup.Largerrandomizedtrialsaremandatory.PresentedbyDr.PavelCervinkaatACC.09/i2,Orlando,FL直接PCI患者院前与导管室应用大剂量替罗非班的比较ON-TIME-2研究AGIR-2研究Prospective,multicentre,placebo-controlled,randomisedSTEMI30min-24hrs5000UFH,500mgASA,600mgClopidogrelAngiogramTirofiban*P

5、laceboTransportationPCIcentreAngiogramTirofibanprovisionalTirofibancont’dON-TIME-2oneyrfollow-upn=9842006.6-2007.11PPCI*Bolus:25µg/kg&0.15µg/kg/mininfusionFollow-upON-TIME-2ChristianW.Hammetal.ConclusionsHighdosetirofibanontopofclopidogrel(600mg)intheprehospitalsetti

6、ngissafePre-Hospitalinitiationoftirofiban(HDB)improvesSTresolutionbefore&afterprimaryPCINoincreaseinbleedingriskImprovesoutcomeofprimaryPCIforAMIStrongtrendtoreducedmortalitycontinuesover1yearfollow-upInpatientsundergoingprimaryPCImortalityissignificantlylower.Highes

7、tefficacyinelderly(>65yrs),inKillipclass2andinearlypresenters.ON-TIME-2ChristianW.Hammetal.MICUPatientcallSTEMIundergoingprimaryPCISTEMI20min-12h600mgclopidogrel250mgaspirinUFH60U/kgTirofiban25μg/kgbolus,0.15ug/kgivgttAngiographyAngiographyPre-hospitalMICUtranspor

8、tationCathlabRandomizeOpenLabelMedicalDispatcherTirofiban25μg/kgbolus,0.15ug/kgivgttAGIR2(n=156)(n=156)PPCIEricBonnefoyetal.3.21.