ACEI在2018STEMI指南地位资料教程.pptx

ACEI在2013版ACC/AHA STEMI指南中的地位*Patients with cardiogenic shock or severe heart failure initially seen at a non–PCI-capable hospital should be transferred for cardiac catheterization and revascularization as soon as possible, irrespective of time delay from MI onset (Class I, LOE: B). ?Angiography and revascularization should not be performed within the first 2 to 3 hours after administration of fibrinolytic therapy.Reperfusion Therapy for Patients with STEMIIIIIaIIaIIbIIbIIIIIIRegional Systems of STEMI Care, Reperfusion Therapy, and Time-to-Treatment Goals BBAll communities should create and maintain a regional system of STEMI care that includes assessment and continuous quality improvement of EMS and hospital-based activities. Performance can be facilitated by participating in programs such as Mission: Lifeline and the D2B Alliance. Performance of a 12-lead ECG by EMS personnel at the site of FMC is recommended in patients with symptoms consistent with STEMI. Primary PCI in STEMIAdjunctive Antithrombotic Therapy to Support Reperfusion With Primary PCI*The recommended maintenance dose of aspirin to be used with ticagrelor is 81 mg daily.Routine Medical TherapiesRenin-Angiotensin-Aldosterone System InhibitorsIIIIaIIaIIbIIbIIIIIIRenin-Angiotensin-Aldosterone System InhibitorsABAn ACE inhibitor should be administered within the first 24 hours to all patients with STEMI with anterior location, HF, or EF less than or equal to 0.40, unless contraindicated. An ARB should be given to patients with STEMI who have indications for but are intolerant of ACE inhibitors. IIIaIIbIIIRenin-Angiotensin-Aldosterone System InhibitorsBAn aldosterone antagonist should be given to patients with STEMI and no contraindications who are already receiving an ACE inhibitor and beta blocker and who have an EF less than or equal to 0.40 and either symptomatic HF or diabetes mellitus. IIIaIIbIIIAACE inhibitors are reasonable for all patients with STEMI and no contraindications to their use. Renin-A