冠心病的治疗策略-这些病例我们可以“不做”.ppt
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1、规范化介入治疗,这样的病例,我们可以“不做”,?,武汉亚洲心脏病医院 朱国英,冠 心 病,药物治疗,介入治疗,外科手术,冠心病的治疗策略,危险因素,血运重建,可以做 适应证,不可以做 禁忌证,可以不做 权衡利弊,Balloon Angioplasty,Stents,Drug Eluting Stents,1977-1989,1990-2000,2001-,可以做 适应证,不可以做 禁忌证,可以不做 权衡利弊,CRF DES Evidence-based Medicine Guidelines Summary 2007,可以做 适应证,不可以做 禁忌证,可以不做 权衡“利弊”,把握“分寸”,OA
2、T Trial - Study Design,Primary Endpoints: Death, MI, or NYHA class IV heart failure,PCI with stenting n=1082,Medical Therapy n=1084,2166 patients with angiography on day 3-28 post-MI revealing total occlusion of the infarct-related artery with TIMI flow grade 0 or 1; and meeting a criterion for incr
3、eased risk, defined as EF 2.5 mg/dl, angiographically significant left main or three-vessel coronary artery disease, angina at rest, or severe ischemia on stress testing. Randomized. 22% female, mean age 59 years, mean follow-up 3 years, mean EF 48% at baseline Concomitant medications: Aspirin, anti
4、coagulation if indicated, ACE inhibitors, beta-blockers, and lipid-lowering therapy, unless contraindicated,Presented at AHA 2006,COURAGE : Study design,Boden WE et al. Am Heart J. 2006;151:1173-9. Boden WE et al. N Engl J Med. 2007;356:1503-16.,Optimal medical therapy* + PCI (n = 1149),Optimal medi
5、cal therapy (n = 1138),AHA/ACC Class I/II indications for PCI, suitable coronary artery anatomy + 70% stenosis in 1 proximal epicardial vessel + objective evidence of ischemia (or 80% stenosis + CCS class III angina without provocation testing),Primary outcomes: All-cause mortality, nonfatal MI,Foll
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