非ST段抬高性急性冠脈綜征的PCI策略研究

1、非ST段抬高性急性冠脈綜征的PCI策略研究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 with the interventional strategy(p0.0001)FRI

2、SC-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 groups, fewer MIs in invasive grou

3、p. 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(18.6%)TIMI IIIB52/484(10.8%)62/

4、509(12.2%)Combined risk ratio 0.88(95%CI 0.78-0.99)0.10.51.02.010.0早期侵入治療優(yōu)于早期保守治療這些試驗比較些什么?早期介入治療與早期保守治療？早期介入策略與早期保守策略？非ST斷抬高性急性冠脈綜合的介入治療是早期介入策略獲益！非ST斷抬高性急性冠脈綜合的介入策略是早期介入策略獲益！早期介入策略如何獲益？UA & NSTEMIEarly invasive vs. early conservative strategiesEarly invasive: Early coronary arteriography followed b

5、y revascularization as indicated by arteriographic findingsEarly conservative: Catheterization, and if indicated, revascularization, only in the event of failure of medical therapy 6-month Mortality for Acute Coronary SyndromesT-wave inversionACSST ACSGranger CB et al. J Am Coll Cardiol. 1998; 31:79

6、A.% Cumulative mortality at 6 monthsST MI with fibrinolytics2457 patients with ACS (follow-up 6 months)Early Invasive Strategies-FRISC Lancet 1999, Vol35404/05:我們的策略是否有所改變？ICTUS研究對我們的啟示Class I:一、無嚴(yán)重合并癥,合并以下高危因素,早期介入治療:1 抗缺血治療中,反復(fù)休息時或輕微活動時胸痛/缺血2 TnT 或TnI升高3 新出現(xiàn)ST段壓低4 反復(fù)胸痛/缺血,伴CHF癥狀,S3奔馬律,肺水腫,MR5 非創(chuàng)傷性

7、負(fù)荷試驗高危發(fā)現(xiàn)非ST段抬高性ACS早期介入干預(yù)時機-AHA/ACC指南（2002）Class I:6 LV收縮功能降低(EF.40負(fù)荷試驗非低危低危藥物治療反復(fù)缺血癥狀心衰嚴(yán)重心律失常EF.40早期介入策略早期保守策略ACS: 院內(nèi)治療UA/NSTEMI:血運重建術(shù)策略心導(dǎo)管術(shù)藥物治療、PCI 或 CABG1 支或 2支病變PCI 或 CABG否CABG心衰或糖尿病CABG是查胸痛原因無3支或2支(伴LAD近端)病變冠心病有左主干病變是無小結(jié)早期介入策略優(yōu)于早期保守策略早期介入策略的意義在于通過冠脈造影深化危險分層早期介入策略使中危和高危病人獲益THANK YOU!Early invasiv

8、e 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 medical therapyUA & NSTEMIBenefit of Intervention7.68.39.614.5051015Patien