急性心肌梗死的药物溶栓和介入治疗课件.ppt

急性心肌梗死的药物溶栓和介入治疗;时间就是心肌，就是生命;90年代中已证明溶栓治疗的益处与安慰剂对比;;溶栓与介入的比较;NRMI-2: 死亡率与时间的关系;2004ACC/AHAAMI指南的选择的推荐;我们已经知道;溶栓与PCI选择之考虑;;选择依据1---起病长短;选择依据2---拖延时间起病早3h到院者PCI/溶栓的衡量;选择依据2---拖延时间NRMI资料;选择依据3---患者本身风险DANAMI-2发现转运PCI有益于高危者;选择依据4年龄，梗死部位，就诊时间;直接PCI的可接受延搁时间取决于患者病情;越是高危，PPCI越经“拖”;直接PCI的可接受延搁时间取决于患者病情;溶栓后还可以PCI吗？;溶栓成功后的PCI--- 不行到可行的过程;Immediate PCI;Immediate PCI---no good;Immediate PCI？80-90’s data suggest harmful;ACC/AHA2004 AMI Guideline described early angiogram after successful lytic;ACC/AHA2005 PCIGuideline described early angiogram after successful lytic;06 ESC AMI guideline :OK;Key trials for immediate PCI OK;CAPITAL further support routine PCI after lysis;;;07 further meta-analysis：new evidence of PCI reasonable after lysis;溶栓后立即或缺血驱动PCI荟萃;为什么又行了？;溶栓失败后的Rescue PCI--- 不得不行到可行的过程; Rescue PCI—early;Rescue PCI(GUSTO-1);GUSTO-1---不补救更好; Key trial for rescue PCI;Meta analysis of Rescue PCI2007;易化PCI---与溶栓后PCI有区别 区别在哪里？;PACT;PACT;CAPTIM Trial arouse some hope ;Key trials for facilitate PCI;FINESSE;Meta analysis for F-PCIprePCI TIMI flow not transfer to good outcome;Meta analysis for F-PCI;Facilitate PCI 2007 guideline ;Pharmacoinvasive概念的提出;转运是安全的;易化，立即，转运的综合;转运与立即PCI的结合;转运与立即PCI的结合:Sx2hTNK;溶栓后PCI Meta2010;溶栓后PCI获益;溶栓后PCI Meta-2011;溶栓后PCI Meta-2011;Latest Guideline, What’s new?;2010ESC介入指南;rt-PA半量溶栓后早期PCI治疗急性STEMI ——疗效及安全性评价;Time intervals;2 with no lesions ≥50% diameter stenosis and 1 with unsuitable anatomy did not undergo PCI;Procedural characteristics (n=46) ;Improved TIMI grade flow ;48.5±32.1;Improved MBG ;59.7±37.2;137.5±57.3;Clinical outcomes at 30days after symptom onset (n=47) ;Take Home Message;