高危ami患者pci治療策略課件

1、高危AMI患者PCI治療策略探討 溫州醫(yī)學院附屬第一醫(yī)院心內科 李晟急性心肌梗死合并低血壓體檢仔細床旁心超急診PCI前常規(guī)心影攝片漂浮導管Intra-Aortic Balloon Pump預防性IABC*美國其他國家P值1997463/2684 (17.3%)1998971/4720 (20.6%)48/426 (11.3%)0.000519991387/5344 (26.0%)102/892 (11.4%)0.000520001517/4850 (31.3%)224/1138(19.7%)0.00052001576/1842 (31.3%)96/473 (20.3%)0.0005預防性應用：

2、IABP 插入早于介入European Heart Journal (2003) 24, 17631770Benchmark 注冊研究IABP適應癥與插入特征美國其他P值PCI支持和穩(wěn)定 N(%)4143 (21.1)357 (11.8)0.001插入前收縮壓 mmHg110.090.0插入IABP地點 N(%)12797 (65.2)1193 (39.4)0.001住院5天后IABP N(%)2677 (13.6)519 (17.1)0.001主要并發(fā)癥總例數(shù)N=22663美國N=19636其他國家N=3027P 值IABP相關死亡12 (0.053)10 (0.051)2 (0.066)0

3、.736嚴重肢體缺血194 (0.9)169 (0.9)25 (0.8)0.847嚴重出血*196 (0.9)173 (0.9)23 (0.8)0.790反搏失敗/球囊漏氣827 (3.6)704 (3.6)123 (4.1)0.341嚴重出血*：穿刺部位血栓負荷重 Glycoprotein IIb/IIIa InhibitorsIt is reasonable to start treatment with abciximab as early as possible before primary PCI (with or without stenting) in patients with

4、 STEMI.Treatment with tirofiban or eptifibatide may be considered before primary PCI (with or without stenting) in patients with STEMI.Time after Bolus (minutes)1530456012006080100AbciximabTirofiban 10 g/kg bolusTirofiban 20 g/kg bolusTirofiban 25 g/kg bolus85%Inhibition of Maximal Aggregation (%)In

5、duced by 20 M of ADP阿昔單抗與不同負荷劑量替羅非班Schneider D, et al. Am J Cardiol. 2003;91:334-336. 血管造影終點TIMI 血流分級TIMI 灌注分級TMPG=TIMI myocardial perfusion grade.Danzi B, et al. Am J Cardiol. 2004;94:35-39.50454035302520151050P=1.0PrePostPrePostAbciximabTirofibanNumber of patientsTIMI 3TIMI 2TIMI 0-150454035302520151050PrePostPrePostAbciximabTirofibanNumber of patientsTMPG 3TMPG 2TMPG 0-1P=0.65使用遠端保護裝置。 遠端保護裝置的臨床研究SuperiorityNon-InferiorityGuardWireGW & FWGW & FWGuardWireTri