探索STEMI抗凝、抗血小板治疗临床管理策略.ppt

* * 单用ASA的标准治疗和加用氯吡格雷的标准治疗相比，仅仅加用了氯吡格雷300mg负荷剂量以及每天1次75mg维持剂量，可使30天的联合终点事件降低20%， 包括了心源性死亡，心肌梗死以及紧急血运重建病人的比例大幅度降，有统计学差异。 * 单用ASA的标准治疗和加用氯吡格雷的标准治疗相比，仅仅加用了氯吡格雷300mg负荷剂量以及每天1次75mg维持剂量，可使30天的联合终点事件降低20%， 包括了心源性死亡，心肌梗死以及紧急血运重建病人的比例大幅度降，有统计学差异。 COMMIT (氯吡格雷 and Metoprolol in Myocardial Infarction Trial) Collaborative Group. Addition of 氯吡格雷 to aspirin in 45 852 patients with acute myocardial infarction: randomised 安慰剂-controlled trial. Lancet. 2005;366:1607-1621. * 30天时,氯吡格雷显著减少了临床终点的发生率 1 氯吡格雷减少心血管死亡、再发心肌梗死或再发缺血所致的紧急血运重建约 20%: 0.80 (95% CI [0.65–0.97]; p=0.026)1 Reference 1. Sabatine MS et al. New Engl J Med 2005; In press. * * 这张片子显示STEMI患者接受不同支架置入术进行心肌再灌注的获益对比，结果发现：单用支架优于单用PTCA，应用药物洗脱支架优于普通支架，直接支架置入优于球囊加支架。 * Looking at the per protocol population of those patients who underwent a PCI, pretreatment with a 300mg loading dose of 波立维 led to an 18.5% relative reduction in the risk of 死亡, MI, and urgent target vessel revascularization at 28 days that did not achieve statistical significance (95% CI, 14.2 – 41.8, p=0.23).1 The relative risk reduction for the per protocol endpoints (MI, 死亡, TVR or MI, 死亡) also showed similar risk reductions. The results observed in the early phase were consistent with those of other trials in the area: EPISTENT, TARGET, PCI-CURE. In CREDO, good standard of care in the overall study population led to a lower than expected overall event rate in the trial (8.3% actual vs 13.4% planned) which may have contributed to the observed results. The time to PCI in the CREDO trial was much shorter than in previous trials in patients undergoing PCI (mean: 9.8 hours). For example, in the PCI-CURE2 trial, the mean time between randomization and PCI was 10 days. References: Steinhubl SR, Berger PB, Tift Mann III J, et al. JAMA, November 20, 2002 – Vol 288, No 19: 2411 – 2420. Mehta SR et al. Lancet. 2001: 358: 527–33. * The CREDO results demonstrate the significant benefits of long-term (1 year) administration of 波立维 in patients undergoing PCI.1