第2单元 急性心肌梗死直接PCI.ppt

术 中 血管径路选择 临时起搏电极 冠脉造影 支架置入 IABP应用 DPD应用 血管径路的选择 桡动脉？ 股动脉？ -2个7F鞘 股静脉和股动脉 左冠脉2-3个体位 强调迅速 避免重复操作 少用对比剂 少吃线，放射安全 右冠脉2个体位 体位选择 梗死相关动脉 尽量减少造影剂、减少射线量，缩短时间 直接PCI原则 迅速开通闭塞血管 避免处理非IRA 尽可能少预扩张，尽可能少后扩张 尽快稳定血流动力学状态 Slide includes recommendations in UA/NSTEMI focused update not in the 2011 PCI GL * ACCF/AHA/SCAI关于AMI直接PCI指南解析 Yida Tang, MD, PhD Dept. of Cardiology, Fuwai Hospital Chinese Academy of Medical Sciences National Center for Cardiovascular Disease 2010 ESC coronary revascularization guideline 2011 ACC AHA PCI guideline 2012 ACC AHA NSTEMI guideline 2012 ESC Definition of MI Guideline 2012 ESC NSTEMI Guideline 2013 ACC AHA definition of MI 2013 ACC AHA STEMI guideline 2013 ESC STEMI Guideline Class of Recommendation (COR) COR Benefit/Risk Key Words (The procedure or treatment…) Class I Benefit Risk Should be performed/administered Is recommended Is indicated Is useful/effective/beneficial Class IIa BenefitRisk Is reasonable Can be useful/effective/beneficial Is probably recommended or indicated Class IIb Benefit ≥Risk May/might be considered or be reasonable Usefulness/effectiveness is unknown/unclear/uncertain or not well established Class III – No Benefit Not helpful No proven benefit Is not recommended/indicated Should not be performed/administered Is not useful/beneficial/effective Class III – Harm Harmful Excess cost without benefit or harmful Potentially harmful Causes harm Should not be performed/administered GNL 2011 Level of Evidence (LOE) LOE Criteria A Multiple populations evaluated Data derived from multiple randomized clinical trials or meta-analyses B Limited populations evaluated Data derived from a single randomized trial or nonrandomized studies C Very limited populations evaluated Only consensus opinion of experts, case studies, or standard of care GNL 2011 STEMI急诊PCI方式 直接(primary, direct)PCI：不溶栓直接行PCI 补救(rescue, salvage)PCI：溶栓失败后行PCI 即刻(immediate)PCI：溶栓成功对严重残余狭窄行PCI 延迟(delayed, deferred)PCI：溶栓后1-7天行PCI PCI in STEMI* Indications COR LOE P