1、非非STST断抬高性断抬高性急性冠脉综合的介入治疗急性冠脉综合的介入治疗RITA-3-resultsinterventionconservativeRR(95%CI)pn=895n=9154-MonthD/MI/Angina86(9.6%)133(14.5%)0.66(0.51-0.85)0.0011-yearD/MI68(7.6%)76(8.3%)0.91(0.67-1.25)0.58Symptoms of angina were improved and use of antianginal medications reduced with the interventional strat
2、egy(p0.0001)FRISC-II 2 years follow-up JACC 2002.40:1902-14invasive conservative RR(95%CI)PMortality(%)3.7 5.40.68(0.47-0.98)0.038MI(%)9.2 12.70.72(0.57-0.91)0.005D/MI(%)12.1 16.30.74(0.61-0.09)0.003 After the first year,there was no difference in mortality between the two groups,fewer MIs in invasi
3、ve group.Number of D/MIs within 1 yearInvasiveConservativeRITA 368/895(7.6%)76/915(8.3%)VINO4/64(6.3%)15/67(22.4%)TACTICS-TIMI1881/1114(7.3%)105/1106(9.5%)TRUCS6/76(7.6%)12/72(16.7%)FRISC II127/1219(10.4%)174/1234(14.1%)MATE11/111(9.9%)6/90(6.7%)VANQWISH111/462(24.0%)85/458(18.6%)TIMI IIIB52/484(10.
4、8%)62/509(12.2%)Combined risk ratio 0.88(95%CI 0.78-0.99)0.10.51.02.010.0早期侵入治疗优于早期保守治疗早期侵入治疗优于早期保守治疗这些试验比较些什么?早期介入治疗与早期保守治疗？早期介入治疗与早期保守治疗？早期介入策略与早期保守策略？早期介入策略与早期保守策略？非非ST断抬高性断抬高性急性冠脉综合的介入治疗急性冠脉综合的介入治疗 是早期介入策略获益！是早期介入策略获益！非非ST断抬高性断抬高性急性冠脉综合的介入策略急性冠脉综合的介入策略 是早期介入策略获益！是早期介入策略获益！早期介入策略如何获益？早期介入策略如何获益？U
5、A&NSTEMIEarly invasive vs.early conservative strategies Early invasive:Early coronary arteriography followed by revascularization as indicated by arteriographic findings Early conservative:Catheterization,and if indicated,revascularization,only in the event of failure of medical therapy 6-month Mort
6、ality for Acute Coronary SyndromesT-wave inversionACSST ACSGranger CB et al.J Am Coll Cardiol.1998;31:79A.%Cumulative mortality at 6 monthsST MI with fibrinolytics 2457 patients with ACS(follow-up 6 months)Early Invasive Strategies-FRISC Invasive(n=1222)Non-invasive(n=1226)RiskradioPDeath,MIor both1
7、13(9.4%)148(12.1%)0.780.031MI94(7.8%)124(10.1%)0.770.045Death23(1.9%)36(2.9%)0.650.10Lancet 1999,Vol354 04/05:我们的策略是否有我们的策略是否有所改变？所改变？ICTUS研究对我们的启示研究对我们的启示Class I:Class I:一、无严重合并症一、无严重合并症,合并以下高危因素合并以下高危因素,早期介入治疗早期介入治疗:1 1 抗缺血治疗中抗缺血治疗中,反复休息时或轻微活动时胸痛反复休息时或轻微活动时胸痛/缺血缺血2 TnT 2 TnT 或或TnITnI升高升高3 3 新出现新出现
8、STST段压低段压低4 4 反复胸痛反复胸痛/缺血缺血,伴伴CHFCHF症状症状,S3,S3奔马律奔马律,肺水肿肺水肿,MR,MR5 5 非创伤性负荷试验高危发现非创伤性负荷试验高危发现非非STST段抬高性段抬高性ACSACS早期介入干预早期介入干预时机时机-AHA/ACCAHA/ACC指南（指南（20022002）Class I:Class I:6 LV6 LV收缩功能降低收缩功能降低(EF0.4)(EF.40负荷试验负荷试验非低危非低危低危低危药物治疗药物治疗反复缺血症状反复缺血症状心衰心衰严重心律失常严重心律失常EF.40早期介入策略早期介入策略早期保守策略早期保守策略ACS:院内治疗院
9、内治疗UA/NSTEMI:血运重建术策略否是小结小结 早期介入策略优于早期保守策略 早期介入策略的意义在于通过冠脉造影深化危险分层 早期介入策略使中危和高危病人获益THANK YOU!Early invasive vs.early conservative strategiesEarly invasive:early coronary arteriography followed by revascularization as indicated by arteriographic findingsEarly conservative:catheterization,and if indicated,revascularization,only in the event of failure of medical therapyUA&NSTEMI演讲完毕，谢谢观看！Thank you for reading!In order to facilitate learning and use,the content of this document can be modified,adjusted and printed at will after downloading.Welcome to download!汇报人：XXX 汇报日期：20XX年10月10日
