非ST段抬高性急性冠脈綜征的PCI策略研究

1、非ST段抬高性急性冠脈綜征的PCI策略研究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 strategy(p0.0001)FRI

2、SC-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 invasive grou

3、p. 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(10.8%)62/

4、509(12.2%)Combined risk ratio 0.88(95%CI 0.78-0.99)0.10.51.02.010.0早期侵入治療優(yōu)于早期保守治療這些試驗(yàn)比較些什么?早期介入治療與早期保守治療？早期介入策略與早期保守策略？非ST斷抬高性急性冠脈綜合的介入治療是早期介入策略獲益！非ST斷抬高性急性冠脈綜合的介入策略是早期介入策略獲益！早期介入策略如何獲益？UA & NSTEMIEarly invasive vs. early conservative strategiesEarly invasive: Early coronary arteriography followed b

5、y revascularization as indicated by arteriographic findingsEarly conservative: Catheterization, and if indicated, revascularization, only in the event of failure of medical therapy 6-month Mortality for Acute Coronary SyndromesT-wave inversionACSST ACSGranger CB et al. J Am Coll Cardiol. 1998; 31:79

6、A.% Cumulative mortality at 6 monthsST MI with fibrinolytics2457 patients with ACS (follow-up 6 months)Early Invasive Strategies-FRISC Lancet 1999, Vol35404/05:我們的策略是否有所改變？ICTUS研究對(duì)我們的啟示Class I:一、無(wú)嚴(yán)重合并癥,合并以下高危因素,早期介入治療:1 抗缺血治療中,反復(fù)休息時(shí)或輕微活動(dòng)時(shí)胸痛/缺血2 TnT 或TnI升高3 新出現(xiàn)ST段壓低4 反復(fù)胸痛/缺血,伴CHF癥狀,S3奔馬律,肺水腫,MR5 非創(chuàng)傷性

7、負(fù)荷試驗(yàn)高危發(fā)現(xiàn)非ST段抬高性ACS早期介入干預(yù)時(shí)機(jī)-AHA/ACC指南（2002）Class I:6 LV收縮功能降低(EF.40負(fù)荷試驗(yàn)非低危低危藥物治療反復(fù)缺血癥狀心衰嚴(yán)重心律失常EF.40早期介入策略早期保守策略ACS: 院內(nèi)治療UA/NSTEMI:血運(yùn)重建術(shù)策略心導(dǎo)管術(shù)藥物治療、PCI 或 CABG1 支或 2支病變PCI 或 CABG否CABG心衰或糖尿病CABG是查胸痛原因無(wú)3支或2支(伴L(zhǎng)AD近端)病變冠心病有左主干病變是無(wú)小結(jié)早期介入策略優(yōu)于早期保守策略早期介入策略的意義在于通過(guò)冠脈造影深化危險(xiǎn)分層早期介入策略使中危和高危病人獲益THANK YOU!Early invasiv

8、e 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 & NSTEMIBenefit of Intervention7.68.39.614.5051015Patien