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1、冠心病治疗策略的演变TheStrategicChangesof CoronaryHeartDiseaseTreatment冠心病治疗观念的改变NovelChangesinConceptofElderlyCHDTreatmentLuminalstenosistovulnerableplaqueformation从重视管腔狭窄到易损斑块Lipiddeposittoinflammatoryresponse从注意脂质沉积到炎症反应Vulnerableplaquetovulnerablepatient从重视易损斑块到易损病人Single
2、RFcontroltomulti-RFintervention从单一危险因素控制到多个危险因素联合干预Standardizedtreatmenttoindividualizedtherapy从注重规范化治疗到个体化治疗2LuminalStenosis管腔狭窄VulnerablePlaque易损斑块冠心病治疗观念改变之一FirstChangeinConcept ofCHDTreatment3DegreeofCoronaryStenosis冠脉狭窄程度RiskofCHD冠心病严重度动脉粥样硬化的传统观念TraditionalCon
3、ceptofAtherosclerosis?4急性心梗前的冠脉狭窄程度CoronaryArteryStenosispre-AMI<50%50-70%>70%%ofDiameterStenosis%ofthePatientsBargraphshowsseverityofcoronaryarterystenosisbeforeAMI(n=195,4studies)68%patientshadstenosislessthan50%atbaseline86%patientshadstenosislessthan70%atbaselin
4、eFalketal.Circulation.1995;92:657.5降脂疗法降低心脏事件但并不改变管腔狭窄Lipid-loweringTherapiesDecreaseCardiacEventsbutNotStenosisTrialCholesterolDecrease,%CardiacEventDecrease,%ChangeinStenosis,%FATS2380-1.1±3.7STARS1469-0.5±3.6STARS2389-1.5±4.0SCRIP16390.3±2.5PLAC119740.69LevineGN,
5、KeaneyJFJr,VitaJA.Cholesterolreductionincardiovasculardisease:clinicalbenefitsandpossiblemechanisms.NEnglJMed..1995;332:512-521.PhilbinEF,PearsonTA.Howdoeslipid-loweringtherapyrapidlyreduceischemicevents?JMyocardIschemia..1994;6:13-18.PittB,ManciniGBJ,EllisSG,Rosman
6、HS,ParkJ-S,McGovernME,forthePLACIinvestigators.Pravastatinlimitationofatherosclerosisinthecoronaryarteries(PLACI):reductioninatherosclerosisprogressionandclinicalevents.JAmCollCardiol..1995;26:1133-11396CoronaryArteryStenosisAndCardiacEvents冠脉狭窄与心脏事件Plaquevolumeorse
7、verityofcoronaryarterystenosismaynotbethekeyfactorforinducingcardiacevents.提示:冠脉狭窄并非心血管事件关键原因7ConceptofVulnerablePlaque易损斑块概念的提出In1989,Mullerandcolleaguesfirstused“vulnerableplaques”todescriberupture-proneplaquesastheunderlyingcauseofmostclinicalcoronaryevents.首倡易损斑
8、块破裂观念Avulnerableplaqueoftenhasalargelipidpool,athincap,andmacrophage-denseinflammationonorbeneathitssurface.特征Vulnerableplaqueruptureordis
