ACS是否应该早期介入治疗.ppt
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1、Is early invasive the answer for ACS,Dr. Ben He MD/PhD/FSCAI/FAPSIC Director of Cardiology Department Renji Hospital Affiliated to Shanghai Jiaotong university,Pathophysiology of Acute Coronary Syndrome,ACS is an Important Manifestation of Atherothrombosis1,1. Cannon CP. J Thromb Thrombolysis 1995;
2、2: 205218.,Antithrombotic,therapy,Stable,angina,UA,Non- Q-wave MI,Thrombolysis primary PCI,Q-wave,MI,Minutes hours,Days weeks,STEMI,UA/NSTEMI,Atherothrombosis,New term,Old term,Plaque rupture,Relation of TIMI risk score and MACE rate,Hot topic in ACS,Is early invasive superior to conservative strate
3、gy in ACS? Should invasive be deferred for cooling off? What is the optimal time for invasive?,Optimal Strategy for UA/NSTEMI,TIMI IIIB,2005,Conservative,Invasive,VANQWISH,FRISC II,TACTICS- TIMI 18,RITA-3,FRICS-II: high risk get more,TIMI-18: high risk get more,RITA-3: 1&3 yrs outcome,RITA-3: 5yrs o
4、utcome,In 2005,It seems we found answer,In ACS, early invasive superior to early conservative This is particular true in high risk patients,ESC Guideline 2005,Is the problem settled?,ICTUS Designed,4 yrs ICTUS Lancet 2007;369:827-835,However, most of selective pts were performed PCI So, the long-ter
5、m f/u results do not inflect Inv/Cons strategy,4 yrs ICTUS Lancet 2007;369:827-835,ICTUSs criticism,Liberty definition of MI (only 1*ULN) causing the early MI increase in early invasive group 3yrs revascularization rate was equal in 2 group(81%PCI) 1year mortality rate in ACS in both arm are very lo
6、w(2.5%),Is it a real high risk?,Even put ICTUS into pool, Inv Cons,Inv vs Cons/All cause death,High risk?,2007 ESC Guideline,Urgent Coronary angiography is recommended in Pts with refractory or recurrent angina associated with dynamic ST deviation, heart failure, life threatening arrhythmias, or hae
7、modynamic instability (I-C) Early(72h) angiography followed by revascularization (PCI or CABG) in patients with intermediate to high risk features is recommended (I-A),2,ISAR-COOL Trial,ISAR-COOL Antithrombotic Regimen,ISAR-COOL,What is the optimal time for PCI?,Methods for Optimal trial,Results of
8、Optimal trial,Conclusion from Optimal trial,Whats the difference between ISAR-Cool & Optimal?,2.5 vs 84 + 0.5 vs 25 -,Time to Coronary Angiography and Outcomes Among Patients With High-Risk NonST-SegmentElevation Acute Coronary Syndromes: Results From the SYNERGY Trial,Pierluigi Tricoci, MD, MHS, Ph
9、D; Yuliya Lokhnygina, PhD; Lisa G. Berdan, PA-C, MHS; Steven R. Steinhubl, MD; Dietrich C. Gulba, MD; Harvey D. White, MD; Neal S. Kleiman, MD; Philip E. Aylward, MD; Anatoly Langer, MD; Robert M. Califf, MD; James J. Ferguson, MD; Elliott M. Antman, MD; L. Kristin Newby, MD, MHS; Robert A. Harringt
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