经皮冠状动脉介入治疗指南(2009)解读.ppt
《经皮冠状动脉介入治疗指南(2009)解读.ppt》由会员分享,可在线阅读,更多相关《经皮冠状动脉介入治疗指南(2009)解读.ppt(64页珍藏版)》请在三一文库上搜索。
1、经皮冠状动脉介入治疗指南(2009)解读,中国医学科学院阜外心血管病医院 高润霖,推荐强度的类别以国际通用的方式表达如下:,指南对适应证的建议,证据的水平以国际通用的方式表达如下,指南对适应证的建议,血管重建策略选择,COURAGE Study,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 medical therapy (n = 1138),AHA/ACC
2、 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,Follow-up: Median 4.6 years,Random
3、ized,*Intensive pharmacologic therapy + lifestyle intervention CCS = Canadian Cardiovascular Society,Secondary outcomes: Death, MI, stroke; ACS hospitalization,Number at Risk,Medical Therapy 1138 1017 959 834 638 408 192 30 PCI 1149 1013 952 833 637 417 200 35,Years,0,1,2,3,4,5,6,0.0,0.5,0.6,0.7,0.8
4、,0.9,1.0,PCI + OMT,Optimal Medical Therapy (OMT),Hazard ratio: 1.05 95% CI (0.87-1.27) P = 0.62,7,Survival Free from Death and MI (median FU 4.6 yrs),Boden WE et al. NEJM 2007;356:1503-16,Freedom from Death or MI (%),Death/MI at 4.6 yrs 19.0% 18.5%,COURAGE: Treatment effect on angina,Boden WE et al.
5、 N Engl J Med. 2007;356:1503-16.,P 0.001,P = 0.02,NS,Angina-free (%),NS,Ischemia reduction 5%,% with Ischemia Reduction 5% Myocardium,p=0.007,PCI + OMT (n=54),OMT (n=51),In 105 pts with moderate-to-severe baseline ischemia,Shaw LA. AHA 2007,Death or MI Rate (%),Rates of Death or MI by Ischemia Reduc
6、tion,p=0.001,Ischemia Reduction 5% (n=68),No Ischemia Reduction (n=37),Shaw LA. AHA 2007,In 105 pts with moderate-to-severe baseline ischemia,1.慢性稳定性冠心病: PCI是缓解慢性稳定性冠心病患者症状的有效方法之一。 与药物治疗相比总体上不能降低死亡及MI发生率, 但有证据表明,在有较大范围心肌缺血的患者中PCI仍比药物治疗具有优势。 PCI应主要用于有效药物治疗的基础上仍有症状的患者以及有明确较大范围心肌缺血证据的患者。,慢性稳定性冠心病PCI推荐指
7、征,Intended all-comers study design instead of a highly selected patient population Consensus physician agreement (surgeon & cardiologist) instead of inclusion & exclusion criteria And, nested registries for CABG only and PCI only to define patient characteristics and outcomes of these two unique tre
8、atment options,SYNTAX: Intended All-Comers Design with Nested Registries,23 US Sites,62 EU Sites,+,SYNTAX Trial Design,*TAXUS Express,Adverse Events to 12 Months,ITT population,Event Rate 1.5 SE, *Fisher exact test,All Death,Revascularization,CVA (Stroke),Myocardial Infarction,TAXUS* (N=903),CABG (N
9、=897),MACCE to 12 Months,P=0.0015*,ITT population,12.1%,17.8%,Event Rate 1.5 SE. *Fishers Exact Test,Symptomatic Graft Occlusion & Stent Thrombosis to 12 Months,MACCE to 12 Months Left Main Subset,P=0.44*,13.6%,15.8%,Event rate 1.5 SE, *Fisher exact test,ITT population,Patient Profiling,Local Heart
10、team (surgeon & interventional cardiologist) assessed each patient in regards to : Patients operative risk (EuroSCORE & Parsonnet score) Coronary lesion complexity (Newly developed SYNTAX score) Goal: SYNTAX score to provide guidance on optimal revascularization strategies for patients with high ris
11、k lesions,Sianos et al, EuroIntervention 2005;1:219-227 Valgimigli et al, Am J Cardiol 2007;99:1072-1081 Serruys et al, EuroIntervention 2007;3:450-459,BARI classification of coronary segments Leaman score, Circ 1981;63:285-299 Lesions classification ACC/AHA , Circ 2001;103:3019-3041 Bifurcation cla
12、ssification, CCI 2000;49:274-283 CTO classification, J Am Coll Cardiol 1997;30:649-656,Dominance,P=0.19*,7.7%,13.0%,Event rate 1.5 SE, *Fisher exact test,Calculated by core laboratory; ITT population,MACCE to 12 Months by SYNTAX Score Tertile Low Scores (0-22) LM Subset,Event rate 1.5 SE, *Fisher ex
13、act test,Calculated by core laboratory; ITT population,P=0.54*,15.5%,12.6%,MACCE to 12 Months by SYNTAX Score Tertile Intermediate Scores (23-32) LM Subset,P=0.008*,25.3%,12.9%,Event rate 1.5 SE, *Fisher exact test,Calculated by core laboratory; ITT population,MACCE to 12 Months by SYNTAX Score Tert
14、ile High Scores (33) Left Main Subset,Overall MACCE at 12 Months Left Main Subset,ITT population,(n=705),(n=91),(n=138),(n=218),(n=258),P=0.44,P=1.0,P=0.27,P=0.29,P=0.42,Patients (%),(n=705),(n=91),(n=138),(n=218),(n=258),Patients (%),Safety at 12 Months Death/CVA/MI in the Left Main Subset,P=0.29,P
15、=1.0,P=0.72,P=0.57,P=0.11,MACCE to 12 Months 3VD Subset,P0.001*,19.1%,11.2%,ITT population,Event Rate 1.5 SE, *Fisher exact test,CABG,TAXUS*,P=0.39,3 Vessel Disease*,n=34,n=43,*per protocol and ITT populations had same outcome,Combined Safety (Death/CVA/MI) 3VD,Patients (%),MACCE to 12 Months vs SYN
16、TAX Score,SYNTAX Score 22,P=0.10,P0.001,P=0.71,12-month MACCE, %,SYNTAX Score,KM Estimates, Event Rate 1.5 SE; *chi square test; raw SYNTAX score for illustrative purposes only,RCT ITT pts; site-reported data,SYNTAX Score 23-32,SYNTAX Score 33,Patient 1,Patient 1,Patient 2,Patient 2,LCx 70-90%,RCA3
17、70-90%,LCx 100%,LAD 99%,RCA 100%,There is 3-vessel disease and 3-vessel disease,ACS: Pathophysiology,Ruptured plaque with subocclusive thrombus,Mehta SR et al. JAMA 2005;293:2908-2917,Composite of Death or Myocardial Infarction No./Total (%),Odds Ratio (95% Cl),Favors Routine Invasive,Favors Selecti
- 配套讲稿:
如PPT文件的首页显示word图标,表示该PPT已包含配套word讲稿。双击word图标可打开word文档。
- 特殊限制:
部分文档作品中含有的国旗、国徽等图片,仅作为作品整体效果示例展示,禁止商用。设计者仅对作品中独创性部分享有著作权。
- 关 键 词:
- 冠状动脉 介入 治疗 指南 2009 解读
链接地址:https://www.31doc.com/p-3572357.html