ACS治疗原则培训课件.ppt

ACS治疗原则ACS治疗原则Early RepolarizationBrugada SyndromeAnterior AMIPrinzmetal AnginaPericarditisAcute Inf.AMIST Segment Elevation(Transmural ischemia)Non-infarct ST ElevationACS 治疗原则 2Early RepolarizationBrugada SyST Segment Depression(Non-transmural ischemia)ST Depression NSTEMIT wave inversion NSTEMIACS 治疗原则 3ST Segment Depression(Non-traACS 治疗原则 4ACS治疗原则4NSTE ACS:Key ThemesNSTE ACS:Key ThemesNSTE ACS:a high risk populationNSTE ACS:a high risk population patient risk patient risk benefit from treatment benefit from treatment with medications,an invasive strategywith medications,an invasive strategyInteraction between invasive strategy and Interaction between invasive strategy and pharmacologic txpharmacologic txAntithrombotics cornerstone of treatmentAntithrombotics cornerstone of treatmentAnticoagulants:heparin,LMWH,direct Anticoagulants:heparin,LMWH,direct thrombin inhibitorsthrombin inhibitorsAntiplatelet agents:aspirin,IIb/IIIa,ADP Antiplatelet agents:aspirin,IIb/IIIa,ADP inhibitorsinhibitorsACS 治疗原则 5NSTE ACS:Key ThemesNSTE ACS:Antman EM et al N Engl J Med 1996;335:1342-9ACS 治疗原则 6ACS治疗原则6Invasive vs.Conservative Strategy for ACSInvasive vs.Conservative Strategy for ACSDeath or(re)-MIDeath or(re)-MITrial N PCI Cons Trial N PCI ConsTrial N PCI ConsRITA 3 1810 7.6 8.3 RITA 3 1810 7.6 8.3RITA 3 1810 7.6 8.3VINO 131 6.3 22.4 VINO 131 6.3 22.4VINO 131 6.3 22.4TACTICS 2220 7.3 9.5 TACTICS 2220 7.3 9.5TACTICS 2220 7.3 9.5TRUCS 148 7.6 16.7 TRUCS 148 7.6 16.7TRUCS 148 7.6 16.7FRISC II 2451 10.4 14.1 FRISC II 2451 10.4 14.1FRISC II 2451 10.4 14.1MATE 201 9.9 6.7 MATE 201 9.9 6.7MATE 201 9.9 6.7V ANQUISH 920 24.0 12.2 V ANQUISH 920 24.0 12.2V ANQUISH 920 24.0 12.2Overall 7876 Overall 7876Overall 7876Fox,Lancet 360:743 03 Fox,Lancet 360:743 03Death/(re)Infarction RR=0.88,p=0.05 RR=0.88,p=0.05Intervention better Intervention better 0.1 0.2 0.3 0.5 0.7 1.0 1.5 2.0 0.1 0.2 0.3 0.5 0.7 1.0 1.5 2.0Death/(re)-MI Death/(re)-MIACS 治疗原则 7Invasive vs.Conservative StraCP971744-45%Cons Cons Inv InvTACTICSTIMI 18TACTICSTIMI 18TnT cut point=0.01 ng/mL(54%of pt TnT+)Troponin T:Death,MI,Rehosp ACS,6 MonthsTroponin T:Death,MI,Rehosp ACS,6 MonthsOR=0.52 OR=0.52*P0.001*P0.001Interaction InteractionP0.001 P0.001P=NS P=NS*n=414n=396 n=463 n=495ACS 治疗原则 8CP971744-45%Cons InvTACTICST