急性冠脉综合征后冠脉危险增高的诊断和机制PPT课件.ppt

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1、DiagnosisandMechanismofIncreasedCoronaryRisksoonafterAcuteCoronarySyndromesAttilioMaseriUniversityVita-SaluteSanRaffaele-Milan,Italy15thGWICCBeijing,October2004PersistentInstabilityDukedatabaseRecentTrialsinAcuteCoronarySyndromesTrialAdditionaltherapyEnd-point4-6mon

2、thMIRACLEhighdoseAtorvastatindeath,AMI,unstableangina,cardiacarrest14.8%TACTICSTIMI18Tirofiban+revascularizationearlydeath,AMI,newreadmission16%AgeLeftventricularfunctionEfforttoleranceClinicalPost-dischargeClassificationofPatientswithACSMaseri,IschemicHeartDisease,

3、1995PredictivevalueofMPOforincidenceofdeathandnonfatalmyocardialinfarctionBaldusSetal,Circulation2003300112241636437411313102040608010012014019909192939495969798992000010203C-ReactiveProteinandCADTYPE1InfarctionoutoftheblueprecededandfollowedbycompletestabilityTYPE2

4、UnstableanginafollowedbyinfarctionfollowedbyrecurrentACSMaseriA,ItalianHeartJ2003SpectrumofClinicalPhenotypesBiologicalPhenotypesBiasucciLMetal,Circulation1999BogartyPetal,Circulation2001PersistingCRPelevationpost-dischargepredicsrecurrentinstabilityCRPLevels>3mg/

5、l0102030405060708090100admissiondischarge3months1yearPatients(%)BiasucciLM,Circulation1999BiasucciLM,Circulation1999CRP<3mg/LCRP<3mg/LCRP>3mg/LCRP>3mg/L%Cum.SurvivalP<0.001EventfreesurvivalaccordingtoCRPlevelsatdischargeinUAMonthsMultipleunstablelesionsGoldsteinetal

6、.NEJM2000ZairisMetal.Atherosclerosis2000WidespreadinflammationinACSWidespreadcoronaryinflammationBuffonAetal.NEJM2002Infectiousandnoninfectiousagents:bacteria,viruses,oxydants,toxinsEnhancedinflammatoryresponsivenessMaseriNEJM1997;Liuzzo:Circulation1998,2001;JACC199

7、9ImmunologicalstimuliCirculation:Liuzzo1999,2000,Caligiuri2000,Biasucci2003MechanismsofInflammationinACSConclusionsTheinflammatorymechanismsaremultipleandnotequallyimportantinallpatientswithACS.Theirpreciseidentificationisrequiredforatargettedpreventionofinflammatio

8、nInhibitionofkeyinflammatoryfinaltriggersofthrombosisappearsanattractivetherapeutictarget.Patientswithrecurrentinstabilityandelevatedinfla