急性冠脉综合征评估及危险分层PPT课件.ppt

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1、AcuteCoronarySyndromesEvaluationandRiskStratificationNewTerminologyinACSACS,acutecoronarysyndrome;MI,myocardialinfarction;UA,unstableangina;NSTEMI,non–ST-segmentelevationmyocardialinfarction;STEMI,ST-segmentelevationmyocardialinfarction;PCI,percutaneouscoronaryintervention.Canno

2、nCP.JThrombThrombolysis.1995;2:205-218.AntithromboticTherapyStableAnginaUnstableAnginaNon–Q-waveMIThrombolysisPrimaryPCIQ-waveMIMinutes-hoursDays-weeksSTEMIUA/NSTEMIAtherothrombosisNewtermOldtermPlaqueRuptureTroponinI(TnI),C-ReactiveProtein(CRP),andB-typeNatriureticPeptide(BNP

3、)asDeterminantsof30-DayMortalityRisksinAcuteCoronaryIschemia:AMultimarkerApproachP=.014P<.001671501557850471732490SabatineM,etal.Circulation.2002;105:1760-1763.(withpermission)ProgressivemechanicalobstructionSecondaryUA(bMVO2)Inflammation/infectionDynamicobstructionNonocclusivethr

4、ombusonpre-existingplaqueBraunwaldE.Circulation.1998;98:2219-2222.BraunwaldEtiologicClassificationofUAGUSTOIIb:Correlationof6-MonthMortalityWithBaselineECGFindingsinPatientsWithACSCumulativeMortality(%)02468100306090120150180DaysFromRandomizationT-waveinversionSTACSSTEMIwithfib

5、rinolyticsGUSTO,GlobalUseofStrategiesToOpenOccludedArteriesinAcuteCoronarySyndromes;ECG,electrocardiogram;ACS,acutecoronarysyndrome;STEMI,ST-segmentelevationmyocardialinfarction.SavonittoS,etal.JAMA.1999;281:707-713.(withpermission)TIMI,thrombosisinmyocardialinfarction;UA,unstable

6、angina;NSTEMI,non–ST-segmentelevationmyocardialinfarction;CAD,coronaryarterydisease.AntmanEM,etal.JAMA.2000;284:835-842.TIMIRiskScoreforUA/NSTEMI:7IndependentPredictorsAged≥65years≥3CADriskfactorsPriorCAD(stenosis>50%)Aspirininlast7days>2anginaleventsin≤24hoursSTdeviationElevated

7、cardiacmarkers(CK-MBortroponin)TIMIRiskScoreForUA/NSTEMIAntmanEM,etal.JAMA.2000;284:835-442.(withpermission)Age>65years>3CADRiskFactorsPriorStenosis>50%STdeviation>2Anginalevents<24hoursASAinlast7daysElevCardiacMarkers(CK-MBortroponin)4.78.313.219.926.240.9010203040500/123456/7D

8、/MI/UrgRevasc(%)NumberofRiskFacto