ASSENT- 4 PCI研究PPT课件.ppt

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1、TheAssessmentoftheSafetyandEfficacyofaNewTreatmentStrategyforAcuteMyocardialInfarction(ASSENT-4PCI)TrialASSENT-4PCITrialPresentedatTheEuropeanSocietyofCardiologyHotLineSession2005PresentedbyDr.FransVandeWerfFull-doseTNK+PrimaryPCI60IU/kg,maximum4000IUn=829GPIIb/IIIai

2、nhibitorsallowedonlyforbailoutuseASSENT-4PCITrial1667patientsage>18yearswithSTelevationmyocardialinfarction(summedSTdeviation>6mm);timefromsymptomonsetwithin6hrs;intenttoperformprimaryPCIRandomizedMeanfollow-up:6mos(30daysreportedtodate)63%ofpatientsreceivedclopidogr

3、el/ticlopidineduringPCIAdditionalUFHwasgivento67.4%intheTNK+PCIgroupand70.1%inthePCIalonegroupPresentedatESC2005PrimaryPCI70IU/kg,nomaximumdosen=838GPIIb/IIIainhibitorsallowedatphysiciandiscretionPrimaryEndpoint:Compositeofdeath,shock,orcongestiveheartfailureat90days

4、.SecondaryEndpoint:Compositeofdeath,shock,orcongestiveheartfailureat30days;shockorCHFat90days;singlecomponentsofthecompositeendpoint.ASSENT-4PCITrial:PCIPatientsundergoingPCIamongtwotreatmentgroups(%)p=0.01PatientsundergoingPCIwithstent(%)PresentedatESC2005p=0.02p=0.

5、97PCIwasperformedatamedianof104minutesfollowingTNKbolusadministrationMediantimefromsymptomonsettorandomizationwas140minutesinthecombinedtherapygroupand135minutesinthePCIalonegroup19%ofpatientswererandomizedintheambulanceGPIIb/IIIainhibitoradministrationpriortoandduri

6、ngPCI(%)p<0.001p<0.001GPIIb/IIIainhibitorsweregivenmoreoftenpriortoPCIinthePCIalonetreatmentgroupGPIIb/IIIainhibitorsweregivenmoreoftenduringPCIinthePCIalonetreatmentgroupASSENT-4PCITrial:GPIIb/IIIaInhibitorsPresentedatESC2005ASSENT-4PCITrial:TIMIFlowGradeTIMIgrade3f

7、lowpriortoPCIandTIMIgrade2/3flowpost-PCI(%)p<0.001TIMIgrade3flowpriortoPCIwaspresentmorefrequentlyintheTNK+PCIarm(43.6%vs15.0%)TIMIgrade2/3post-PCIwasslightlyhigherinthePCIalonegroup(95.3%vs97.6%)p=0.03PresentedatESC2005ASSENT-4PCITrial:AbruptClosure,Re-infarction,an

8、dRepeatTVRAnalysisofin-hospitalabruptclosure,re-infarction,andrepeatTVR(%)p<0.001In-hospitalabruptclosureoccurredmoreoftenintheTNK+