急性冠脉综合征患者冠脉介入治疗指南-英文

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1、GuidelinesforCoronaryInterventioninACSMichaelKYLeeQueenElizabethHospital李耿渊香港伊丽莎白医院SCC2008DivisionofCardiologyDepartmentofMedicineACC/AHA2007GuidelinesfortheManagementofPatientsWithUnstableAngina/Non–ST-ElevationMyocardialInfarctionHospitalizationsintheU.S.DuetoACS

2、AcuteCoronarySyndromes*1.57MillionHospitalAdmissions-ACSUA/NSTEMI†STEMI1.24millionAdmissionsperyear0.33millionAdmissionsperyear*Primaryandsecondarydiagnoses.†About0.57millionNSTEMIand0.67millionUA.HeartDiseaseandStrokeStatistics–2007Update.Circulation2007;115:69–17

3、1.PrimaryPCIforSTEMISTEMIpatientspresentingtoahospitalwithPCIcapabilityshouldbetreatedwithprimaryPCIwithin90minoffirstmedicalcontactasasystemsgoal.STEMIpatientspresentingtoahospitalwithoutPCIcapability,andwhocannotbetransferredtoaPCIcenterandundergoPCIwithin90minof

4、firstmedicalcontact,shouldbetreatedwithfibrinolytictherapywithin30minofhospitalpresentationasasystemsgoal,unlessfibrinolytictherapyiscontraindicated.IIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIII

5、IIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIAstrategyofcoronaryangiographywithintenttoperformPCI(oremergencyCABG)isrecommendedinpatientswhohavereceivedfibrinolytictherapyandhave:Cardiogenicsh

6、ockinpatients<75yearswhoaresuitablecandidatesforrevascularizationb.Severecongestiveheartfailureand/orpulmonaryedema(KillipclassIII)c.Hemodynamicallycompromisingventriculararrhythmias.IIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIIIIaIIaIIaIIbIIbIIbI

7、IIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIII

8、IIIIRescuePCIforSTEMIEarlyRiskStratificationinACSUseofrisk-stratificationmodels,suchastheTIMIorGRACEriskscoreorPURSUITriskmodel,canbeusefultoassi