急性心肌梗死直接pcippt课件

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1、ACCF/AHA/SCAI关于AMI直接PCI指南解析2010ESCcoronaryrevascularizationguideline2011ACCAHAPCIguideline2012ACCAHANSTEMIguideline2012ESCDefinitionofMIGuideline2012ESCNSTEMIGuideline2013ACCAHAdefinitionofMI2013ACCAHASTEMIguideline2013ESCSTEMIGuidelineClassofRecommendation(COR)CORBenefit/RiskKeyWords(Theprocedureo

2、rtreatment…)ClassIBenefit>>>RiskShouldbeperformed/administeredIsrecommendedIsindicatedIsuseful/effective/beneficialClassIIaBenefit>>RiskIsreasonableCanbeuseful/effective/beneficialIsprobablyrecommendedorindicatedClassIIbBenefit≥RiskMay/mightbeconsideredorbereasonableUsefulness/effectivenessisunknow

3、n/unclear/uncertainornotwellestablishedClassIII–NoBenefitNothelpfulNoprovenbenefitIsnotrecommended/indicatedShouldnotbeperformed/administeredIsnotuseful/beneficial/effectiveClassIII–HarmHarmfulExcesscostwithoutbenefitorharmfulPotentiallyharmfulCausesharmShouldnotbeperformed/administeredGNL2011Level

4、ofEvidence(LOE)LOECriteriaAMultiplepopulationsevaluatedDataderivedfrommultiplerandomizedclinicaltrialsormeta-analysesBLimitedpopulationsevaluatedDataderivedfromasinglerandomizedtrialornonrandomizedstudiesCVerylimitedpopulationsevaluatedOnlyconsensusopinionofexperts,casestudies,orstandardofcareGNL20

5、11STEMI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-genicshockIBContraindicationstofibrinolytictherapywithischemicsymp

6、toms<12hIBClinicaland/orECGevidenceofongoingischemiabetween12and24haftersymptomonsetIIaBAsymptomaticpatientpresentingbetween12and24haftersymptomonsetandhigherriskIIbCNoninfarctarteryPCIatthetimeofprimaryPCIinpatientswithouthemodynamiccompromiseIII:HarmBDelayedorElectivePCIinPatientswithSTEMI(i.e.No

7、n-PrimaryPCI)ClinicalevidenceforfibrinolyticfailureorinfarctarteryreocclusionIIaBPatentinfarctartery3to24hafterfibrinolytictherapyIIaBIschemiaonnoninvasivetestingIIaBHemodynamicallysignificantstenosisinapat