培训课件--急性冠脉综合征的治疗.ppt

* Goals for AMI Therapy The primary goal of therapy for AMI is to reduce the likelihood of mortality in the post-infarction period. The second and equally important goal is to leave the AMI survivor with an improved outcome.1 Since large infarcts lead to deteriorating pump function and secondary arrhythmias, effective treatments for AMI strive to preserve left ventricular (LV) function , resolve ST-segment elevation, and rapidly restore coronary blood flow to ischemic myocardium.1,2,3 Very early initiation of thrombolytic therapy, within 70 to 90 minutes after the onset of AMI symptoms is associated with improved survival rates and better LV function.3 Complete and sustained thrombolysis with TIMI 3 coronary perfusion is also critical for optimal outcomes,3 as well as for preventing late reocclusion. A key strategy to achieving all these goals is to shorten the time to perfusion. 1. Yusuf S, Sleight P, Held P, et al. Routine medical management of acute myocardial infarction: lessons from overviews of recent randomized controlled trials. Circulation. 1990;82 (suppl II):II-117-II-134. 2. Schr?der R, Wegscheider K, Schr?der K, et al. Extent of early ST segment elevation resolution: a strong predictor of outcome in patients with acute myocardial infarction and a sensitive measure to compare thrombolytic regimens. A substudy of the International Joint Efficacy Comparison of Thrombolytics (INJECT) Trial. J Am Coll Cardiol. 1995;26:1657-1664. 3. Smalling RW, Bode C, Kalbfleisch J, et al. More rapid, complete, and stable coronary thrombolysis with bolus administration of reteplase compared with alteplase infusion in acute myocardial infarction. Circulation. 1995;91:2725-2732. * Evidence exists that expeditious restoration of flow in the obstructed infarct artery after the onset of symptoms in patients with STEMI is the key determinent of short- and long-term outcomes regardless of whether reperfusion is accomplished by fibrinolysis or PCI. Efforts should be made t