溶栓治疗急性心肌梗死.ppt

Combination Lytic Therapy inAcute Myocardial Infarction C. Michael Gibson, M.D. Pathophysiology of Combination Therapy in AMI Recent Clinical Trials Clinical Trials: Ongoing GUSTO-I: A 20% Increase in TIMI Grade 3 Flow is Needed to Yield a 1% Mortality Reduction TIMI Grade 3 Flow – Pooled Data From Dose Confirmation Phases of Recent Trials SPEED: Results of Dose-Confirmation Phase GUSTO-V: Study Design Primary End Point: 30-Day Mortality GUSTO-V: Noninferiority Analysis A Comparison of the Outcomes With r-PA Monotherapy in GUSTO-III vs GUSTO-V Trials GUSTO-V: Causes of Reinfarction Non-Intracranial Bleeding Through Discharge/Day 7 ICH by Age Group GUSTO-V: PCI Within 6 Hours (Urgent) and Through Day 7 GUSTO-V: Event Rates in Those Requiring Urgent PCI GUSTO-V: Conclusions Compared with r-PA monotherapy, combination therapy with r-PA and abciximab resulted in A mortality rate that was not inferior to r-PA monotherapy Fewer nonfatal reinfarctions (primarily a reduced incidence of recurrent ST elevation) A lower rate of urgent revascularization More noncerebral bleeding complications, transfusions, and thrombocytopenia A higher rate of ICH in elderly patients over the age of 75 years ASSENT-3: Rationale for Use of Enoxaparin TNK-tPA plus enoxaparin Favorable effects of LMWHs in recent small-scale thrombolysis trials Higher late patency: HART-2 ASSENT-Plus AMI-SK Less reocclusion: HART-2 Fewer reinfarctions: ASSENT-Plus AMI-SK Wilson, et al. ASSENT-3 is the first large-scale trial to test LMWH ASSENT-3: Study Design ASSENT-3: Primary End Points Primary Efficacy End Point: Composite of 30-day mortality or in-hospital reinfarction or in-hospital refractory ischemia. Primary Efficacy Plus Safety End Point: Composite of 30-day mortality or in-hospital reinfarction or in-hospital refractory ischemia plus in-hospital intracranial haemorrhage or in-hospital major bleeding other than intracranial. ASSENT-3: 30-Day Mortality, Recurrent MI, Refractory Ischemia A