Hamm教授毕业于德国美因兹大学.ppt

流行病学 治疗 流行病学急性冠脉综合征中血糖异常的流行病学和特征– GAMI 研究 - 治疗 ACS中早期 vs 延迟的他汀治疗 目的 Z 期 在按照指南接受ACS治疗的较高危患者中比较早期强化他汀治疗和延迟的传统他汀治疗 研究设计 结论: 早期强化辛伐他汀治疗 1? 复合终点绝对减少2.3%，相对减少11% Post-hoc 分析显示，4~24个月内的主要终点减少25% 辛伐他汀 80 mg 较低剂量出现肌病的风险高 首次证实同一种他汀的高剂量较低剂量有更明显的益处 PROVE IT - TIMI 22: 研究设计 治疗 冠心病的抗生素治疗 – PROVE-IT 背景 PROVE IT - TIMI 22: 研究设计 PROVE IT-TIMI 22 抗生素试验: 总结 “这是采用抗生素减少心肌梗死后事件策略的致命一击” 或 “…美丽的假设被残酷的现实击碎” 这是治疗对LDL-C水平的影响。早期大剂量治疗可获得LDL-C早期明显下降，而且，正如预期的那样，延迟治疗导致下降程度较小。 本图显示，主要终点是随访24个月的心血管死亡、心肌梗死和因急性冠脉综合征或卒中再次入院的复合终点。事件发生率之间没有显著差异，仅较高剂量辛伐他汀组有事件减少的趋势。 但是，4个月时对可评估的无事件患者进行假定分析显示，高剂量组事件发生率明显减少。 因此，结论就是高剂量辛伐他汀有降低主要终点事件的微弱趋势。Post-hoc分析表明4个月无事件患者的主要终点事件减少25%。所以，该研究首次证明同一种他汀药物高剂量较低剂量有明显优势。 血清学研究表明，肺炎衣原体增加心血管事件风险。但是，研究结果并不一致。 PROVE IT is a double-blind, randomized trial that has enrolled 4,160 patients, at approximately 400 sites in the US, Europe, Canada, and Australia, who have experienced an acute coronary syndrome (Q wave and non-Q-wave MI or unstable angina) within the previous 10 days. Patients received either 40 mg of pravastatin or 80 mg of atorvastatin within 10 days of their event and were followed for a mean follow-up period of 2 years. To study the role of infection in ACS, one half of the patients in the trial also received gatifloxacin 400 mg in addition to either pravastatin or atorvastatin. Gatifloxacin was started on day 15 after the initial episode of ACS for a treatment period of 14 days. Gatifloxacin was subsequently given as a pulsed dose of 400mg per day for 10 days each month for a mean of 2 years. The other half of the patient population received an antibiotic placebo. 在PROVE IT – TIMI 22研究中，两组患者进一步随机分组，分别给予加替沙星和安慰剂治疗，并随访两年。 因此，根据该项大型研究，可以得出以下结论：抗生素对急性冠脉综合征的治疗没有影响。 PROVE IT is a double-blind, randomized trial that has enrolled 4,160 patients, at approximately 400 sites in the US, Europe, Canada, and Australia, who have experienced an acute coronary syndrome (Q wave and non-Q-wave MI or unstable angina) within the previous 10 days. Patients received