最新急性冠脉综合征评估及危险分层PPT课件.ppt

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1、急性冠脉综合征评估及危险分层NewTerminologyinACSACS,acutecoronarysyndrome;MI,myocardialinfarction;UA,unstableangina;NSTEMI,non–ST-segmentelevationmyocardialinfarction;STEMI,ST-segmentelevationmyocardialinfarction;PCI,percutaneouscoronaryintervention.CannonCP.JThrombThrombolysis

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

3、terminantsof30-DayMortalityRisksinAcuteCoronaryIschemia:AMultimarkerApproachP=.014P<.001671501557850471732490SabatineM,etal.Circulation.2002;105:1760-1763.(withpermission)TIMIRiskScoreForUA/NSTEMIAntmanEM,etal.JAMA.2000;284:835-442.(withpermission)Age>65years>3CA

4、DRiskFactorsPriorStenosis>50%STdeviation>2Anginalevents<24hoursASAinlast7daysElevCardiacMarkers(CK-MBortroponin)4.78.313.219.926.240.9010203040500/123456/7D/MI/UrgRevasc(%)NumberofRiskFactorsPopulation(%):4.317.332.029.313.03.4CStatistic=0.65c2trendP<.001P<.001

5、P=.004P<.001P<.001SciricaBM,etal.AmJCardiol.2002;90:303-305.(withpermission)TIMIRiskScorevsPrognosisinUnselectedPatients(TIMI3Registry)TRS0-2TRS3-4TRS5-70%10%20%30%40%50%DeathMIDeath/MIDeath/MI/RIEventRateat1year(%)PrognosticValueofTroponinTorIinACS:AMeta-analys

6、is%RR3.9(2.9-5.3)RR3.8(2.6-5.5)No.Studies:136NegPos(TropI+T)36341849737322HeidenreichPA,JAmCollCardiol.2001;38:478-485.TIMIIIIB:TroponinILevelsPredictMortalityInUA/NSTEMI1.01.73.43.76.07.5024680to<0.40.4to<1.01.0to<2.02.0to<5.05.0to<9.0>9.08311741481346750Risk

7、CardiacTroponinI(ng/ml)Ratio1.01.83.53.96.27.8Mortalityat42Days(%ofPatients)AntmanEA,etal.NEnglJMed.1996;335:1342-1349.(withpermission)LindahlB,etal.NEnglJMed.2000;343:1139-1147.(withpermission)PredictiveValueofTroponinTandhs-CRPforMortalityfromACSinFRISCSubstud

8、y201000612182430364248CumulativeProbabilityofDeath(%)MonthsTroponinT>0.60µg/l(n=377)TroponinT0.60-0.59µg/l(n=367)TroponinT<0.60µg/l(n=173)P=.007P=.001CRP2-10mg