急性心肌梗死直接PCI

《急性心肌梗死直接PCI》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。

1、ACCF/AHA/SCAI关于AMI直接PCI指南解析YidaTang,MD,PhDDept.ofCardiology,FuwaiHospitalChineseAcademyofMedicalSciencesNationalCenterforCardiovascularDisease2010ESCcoronaryrevascularizationguideline2011ACCAHAPCIguideline2012ACCAHANSTEMIguideline2012ESCDefinitionofMIGuideli

2、ne2012ESCNSTEMIGuideline2013ACCAHAdefinitionofMI2013ACCAHASTEMIguideline2013ESCSTEMIGuidelineClassofRecommendation(COR)CORBenefit/RiskKeyWords(Theprocedureortreatment…)ClassIBenefit>>>RiskShouldbeperformed/administeredIsrecommendedIsindicatedIsuseful/effecti

3、ve/beneficialClassIIaBenefit>>RiskIsreasonableCanbeuseful/effective/beneficialIsprobablyrecommendedorindicatedClassIIbBenefit≥RiskMay/mightbeconsideredorbereasonableUsefulness/effectivenessisunknown/unclear/uncertainornotwellestablishedClassIII–NoBenefitNoth

4、elpfulNoprovenbenefitIsnotrecommended/indicatedShouldnotbeperformed/administeredIsnotuseful/beneficial/effectiveClassIII–HarmHarmfulExcesscostwithoutbenefitorharmfulPotentiallyharmfulCausesharmShouldnotbeperformed/administeredGNL2011LevelofEvidence(LOE)LOECr

5、iteriaAMultiplepopulationsevaluatedDataderivedfrommultiplerandomizedclinicaltrialsormeta-analysesBLimitedpopulationsevaluatedDataderivedfromasinglerandomizedtrialornonrandomizedstudiesCVerylimitedpopulationsevaluatedOnlyconsensusopinionofexperts,casestudies,

6、orstandardofcareGNL2011STEMI急诊PCI方式直接(primary,direct)PCI：不溶栓直接行PCI补救(rescue,salvage)PCI：溶栓失败后行PCI即刻(immediate)PCI：溶栓成功对严重残余狭窄行PCI延迟(delayed,deferred)PCI：溶栓后1-7天行PCIPCIinSTEMI*IndicationsCORLOEPrimaryPCI*STEMIsymptomswithin12hIASevereheartfailureorcardio-geni

7、cshockIBContraindicationstofibrinolytictherapywithischemicsymptoms<12hIBClinicaland/orECGevidenceofongoingischemiabetween12and24haftersymptomonsetIIaBAsymptomaticpatientpresentingbetween12and24haftersymptomonsetandhigherriskIIbCNoninfarctarteryPCIatthetimeof

8、primaryPCIinpatientswithouthemodynamiccompromiseIII:HarmBDelayedorElectivePCIinPatientswithSTEMI(i.e.Non-PrimaryPCI)ClinicalevidenceforfibrinolyticfailureorinfarctarteryreocclusionIIaBPatentinfa