冠心病循证医学证据与治疗指南的衍变课件.ppt

背景介绍 1999年由美国内科医师学院(ACP)发起，美国内科医师学院--美国内科学会（ASIM）、美国心脏病学院/美国心脏学会(ACC/AHA) 联合制定了慢性稳定性心绞痛患者诊疗指南 2002年ACC/AHA出版了更新的指南，ACP认为该更新版指南对证据和背景文献进行了科学、公正的系统回顾，因此得到ACP的认可 2004年10月，ACP指南对2002年ACC/AHA更新版指南的诊疗推荐进行了再审定,并强调此推荐对于临床医师诊治患者甚为重要 药物治疗原则 治疗稳定性心绞痛有两个主要目的: 首先是预防心梗和死亡并由此延长生命 其次是减少心绞痛的症状和心肌缺血的发生，进而改善生活质量 显然，预防死亡的治疗最为重要。当两种不同的治疗策略在减轻心绞痛症状方面同样有效时，应该优先采用在预防死亡方面有优势的治疗策略。 预防心梗和死亡并减少症状的药物治疗建议 建议1 ：应使用下列药物治疗有症状的慢性稳定性心绞痛患者，以预防心梗或死亡并减轻症状： ACEI（A类证据） 下列药物对有症状的慢性稳定性心绞痛患者仅可在减轻症状时使用： β阻滞剂有明确的禁忌症时，可使用CCB（长效）或长效硝酸酯类药物（B类证据） β阻滞剂单药治疗，不能完全缓解症状时， 可在β阻滞剂的基础上联合使用CCB（长效）或长效硝酸酯类药物（B类证据） ACC/AHA 2002 guideline update for the management of patients with chronic stable angina Content Points: The ACC/AHA guideline update for 20021 class I recommendation for ACE inhibitors state they should be used in all patients with coronary artery disease who also have diabetes and/or LV systolic dysfunction (Level of evidence: A). Class IIa recommendation states ACE inhibitors should be used in patients with coronary artery disease or other vascular disease (Level of evidence: B). These recommendations expand on previous recommendations for ACE inhibitors and were made in response to the results of the HOPE and MICRO-HOPE studies.2,3 In the ACC/AHA classification of recommendations, class I refers to conditions for which there is evidence and/or general agreement that a given procedure or treatment is useful and effective1 In the ACC/AHA classification of recommendations, class IIa refers to conditions for which there is conflicting evidence and/or divergence of opinion about the usefulness/efficacy of a procedure or treatment, with the weight of evidence in favor of usefulness/efficacy1 1 Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS, et al. ACC/AHA 2002 guideline update for the management of patients with chronic stable angina-Summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management o