(精品)非ST段抬高性急性冠脉综合的介入治疗.ppt

《(精品)非ST段抬高性急性冠脉综合的介入治疗.ppt》由会员分享，可在线阅读，更多相关《(精品)非ST段抬高性急性冠脉综合的介入治疗.ppt（34页珍藏版）》请在淘文阁 - 分享文档赚钱的网站上搜索。

1、非非STST断抬高性断抬高性急性冠脉综合的介入治疗急性冠脉综合的介入治疗广东省心血管病研究所广东省心血管病研究所陈纪言陈纪言RITA-3-resultsinterventionconservativeRR(95%CI)pn=895n=9154-MonthD/MI/Angina86(9.6%)133(14.5%)0.66(0.51-0.85)0.0011-yearD/MI68(7.6%)76(8.3%)0.91(0.67-1.25)0.58Symptoms of angina were improved and use of antianginal medications reduced wit

2、h the interventional strategy(p0.0001)FRISC-II 2 years follow-up JACC 2002.40:1902-14invasive conservative RR(95%CI)PMortality(%)3.7 5.40.68(0.47-0.98)0.038MI(%)9.2 12.70.72(0.57-0.91)0.005D/MI(%)12.1 16.30.74(0.61-0.09)0.003 After the first year,there was no difference in mortality between the two

3、groups,fewer MIs in invasive group.Number of D/MIs within 1 yearInvasiveConservativeRITA 368/895(7.6%)76/915(8.3%)VINO4/64(6.3%)15/67(22.4%)TACTICS-TIMI1881/1114(7.3%)105/1106(9.5%)TRUCS6/76(7.6%)12/72(16.7%)FRISC II127/1219(10.4%)174/1234(14.1%)MATE11/111(9.9%)6/90(6.7%)VANQWISH111/462(24.0%)85/458

4、(18.6%)TIMI IIIB52/484(10.8%)62/509(12.2%)Combined risk ratio 0.88(95%CI 0.78-0.99)0.10.51.02.010.0早期侵入治疗优于早期保守治疗早期侵入治疗优于早期保守治疗这些试验比较些什么?早期介入治疗与早期保守治疗？早期介入治疗与早期保守治疗？早期介入策略与早期保守策略？早期介入策略与早期保守策略？非非ST断抬高性断抬高性急性冠脉综合的介入治疗急性冠脉综合的介入治疗是早期介入策略获益！是早期介入策略获益！非非ST断抬高性断抬高性急性冠脉综合的介入策略急性冠脉综合的介入策略是早期介入策略获益！是早期介入策略获益

5、！早期介入策略如何获益？早期介入策略如何获益？UA&NSTEMIEarly invasive vs.early conservative strategiesEarly invasive:Early coronary arteriography followed by revascularization as indicated by arteriographic findingsEarly conservative:Catheterization,and if indicated,revascularization,only in the event of failure of medica

6、l therapy 6-month Mortality for Acute Coronary SyndromesT-wave inversionACSST ACSGranger CB et al.J Am Coll Cardiol.1998;31:79A.%Cumulative mortality at 6 monthsST MI with fibrinolytics2457 patients with ACS(follow-up 6 months)Early Invasive Strategies-FRISC Lancet 1999,Vol35404/05:我们的策略是否有我们的策略是否有所

7、改变？所改变？ICTUS研究对我们的启示研究对我们的启示Class I:Class I:一、无严重合并症一、无严重合并症,合并以下高危因素合并以下高危因素,早期介入治疗早期介入治疗:1 1 抗缺血治疗中抗缺血治疗中,反复休息时或轻微活动时胸痛反复休息时或轻微活动时胸痛/缺血缺血2 2 TnTTnT 或或TnITnI升高升高3 3 新出现新出现STST段压低段压低4 4 反复胸痛反复胸痛/缺血缺血,伴伴CHFCHF症状症状,S3,S3奔马律奔马律,肺水肿肺水肿,MR,MR5 5 非创伤性负荷试验高危发现非创伤性负荷试验高危发现非非STST段抬高性段抬高性ACSACS早期介入干预早期介入干预时机时

8、机-AHA/ACCAHA/ACC指南（指南（20022002）Class I:Class I:6 LV6 LV收缩功能降低收缩功能降低(EF0.4)(EF.40负荷试验负荷试验非低危非低危低危低危药物治疗药物治疗反复缺血症状反复缺血症状心衰心衰严重心律失常严重心律失常EF.40早期介入策略早期介入策略早期保守策略早期保守策略ACS:ACS:院内治疗院内治疗院内治疗院内治疗UA/NSTEMI:UA/NSTEMI:血运重建术策略血运重建术策略心导管术心导管术心导管术心导管术药物治疗药物治疗药物治疗药物治疗、PCI PCI 或或或或 CABG CABG1 1 支或支或支或支或 2 2支病变支病变支病

9、变支病变PCI PCI 或或或或 CABG CABG否CABGCABG心衰或糖尿病心衰或糖尿病心衰或糖尿病心衰或糖尿病CABGCABG是是是是查胸痛原因查胸痛原因查胸痛原因查胸痛原因无无无无3 3支或支或支或支或2 2支支支支(伴伴伴伴LADLAD近端近端近端近端)病变病变病变病变冠心病冠心病冠心病冠心病有有有有左主干病变左主干病变左主干病变左主干病变是无无无无小结小结早期介入策略优于早期保守策略早期介入策略的意义在于通过冠脉造影深化危险分层早期介入策略使中危和高危病人获益THANK YOU!Early invasive vs.early conservative strategiesEarl

10、y invasive:early coronary arteriography followed by revascularization as indicated by arteriographic findingsEarly conservative:catheterization,and if indicated,revascularization,only in the event of failure of medical therapyUA&NSTEMIBenefit of Intervention7.68.39.614.5051015Patients(%)Conservative(n=915)Death/MIDeath/MIat 1 yearat 1 yearDeath/MI/RADeath/MI/RAat 4 monthsat 4 monthsP=0.001 RR 0.66 0.510.85P=NSRR,risk ratioIntervention(n=895)