ESC冠心病热点聚焦.ppt
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1、2013 ESC 冠心病热点聚焦冠心病热点聚焦华中科技大学同济医院心内科华中科技大学同济医院心内科华中科技大学同济医院心内科华中科技大学同济医院心内科国家教育部国家教育部国家教育部国家教育部&卫计部重点学科卫计部重点学科卫计部重点学科卫计部重点学科郭郭郭郭 小小小小 梅梅梅梅 最新最新ESC,AHAESC,AHA指南引入指南引入FMC-DeviceFMC-Device概念概念2012 ESC STEMI guideline2012 ESC STEMI guidelineFMC(First Medical Contact)FMC(First Medical Contact)2013 ACCF/A
2、HA STEMI2013 ACCF/AHA STEMI2013 ACCF/AHA STEMI2013 ACCF/AHA STEMI患者治疗策略选择患者治疗策略选择患者治疗策略选择患者治疗策略选择 新指南新指南新指南新指南3 3 3 3个要点内容个要点内容个要点内容个要点内容uu90909090分钟内急诊分钟内急诊分钟内急诊分钟内急诊PCIPCIPCIPCIuu2 2 2 2小时内转诊小时内转诊小时内转诊小时内转诊PCIPCIPCIPCIuu2 2 2 2小时以上溶栓后转诊小时以上溶栓后转诊小时以上溶栓后转诊小时以上溶栓后转诊PCIPCIPCIPCI30 30 天复合终点荟萃分析:死亡率、再发心
3、梗、心肌缺血天复合终点荟萃分析:死亡率、再发心梗、心肌缺血天复合终点荟萃分析:死亡率、再发心梗、心肌缺血天复合终点荟萃分析:死亡率、再发心梗、心肌缺血DSouza S P et al.Eur Heart J 2011;32:972-982DSouza S P et al.Eur Heart J 2011;32:972-982 Impact of immediate multivessel intervention on outcome of patients with multivessel disease undergoing primary PCI for STEMI without ca
4、rdiogenic shock(Results of the prospective ALKK PCI registry)Results I AnalysisResults I AnalysisPresent data from 2008-2011,immediate multivessel PCI vs culprit lesion PCIPresent data from 2008-2011,immediate multivessel PCI vs culprit lesion PCIAlmost 6000 consecutive patients with STEMI and multi
5、vessel disease includedAlmost 6000 consecutive patients with STEMI and multivessel disease includedImpact of multivessel PCI in STEMIImpact of multivessel PCI in STEMI Results II Treated coronary arteries(%)Results II Treated coronary arteries(%)p0,01p0,01p0,01p0,01p0,01p0,01Impact of multivessel PC
6、I in STEMIResults III Minimal TIMI Flow before and after PCIResults III Minimal TIMI Flow before and after PCI Impact of multivessel PCI in STEMI Results IV Intrahospital events Results IV Intrahospital eventsp0,01p0,01Results V Multivariate analysis on predictors ofResults V Multivariate analysis o
7、n predictors of intrahospital mortality in STEMI patients intrahospital mortality in STEMI patients Impact of multivessel PCI in STEMISummarySummaryImmediate multivessel PCI for STEMI without Immediate multivessel PCI for STEMI without cardiogenic shock is used in a minority of patients(10%)cardioge
8、nic shock is used in a minority of patients(10%)There are no differences in procedural success rates(TIMI 3 There are no differences in procedural success rates(TIMI 3 flow;90,0%vs 90,9%)flow;90,0%vs 90,9%)MV PCI needs significantly more contrast agent(220 vs MV PCI needs significantly more contrast
9、 agent(220 vs 170ml)and fluoroscopy time(12,2 vs 7,8min)170ml)and fluoroscopy time(12,2 vs 7,8min)MV PCI is associated with higher intrahospital mortality as culprit MV PCI is associated with higher intrahospital mortality as culprit lesion PCI(8,5 vs 4,6%)lesion PCI(8,5 vs 4,6%)Impact of multivesse
10、l PCI in STEMI Should We Perform an Immediate Coronary Angiogram in All Survivors of Out-of Hospital Cardiac Arrest With No Obvious Extra-Cardiac Cause?Insights from the PROCAT registryJanuary 2003-December 20086766 cases of OHCACPR attemptedCPR attempted34943494CPR not attemptedCPR not attempted327
11、23272Stable hemodynamic stateStable hemodynamic state11981198Fatal arrest during transportationFatal arrest during transportation484484Successfully transported to hospitalSuccessfully transported to hospital714714714 OHCA successfully transported tothe hospital Obvious non cardiac cause of Obvious n
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