ACS治疗原则双语版-全文可读.pptxVIP

The Management of Acute Myocardial Infarction;Early Repolarization;ST Segment Depression (Non-transmural ischemia);NSTE ACS : Key Themes;Antman EM et al N Engl J Med 1996;335:1342-9;Invasive vs. Conservative Strategy for ACS Death or (re)-MI;CP971744-45;Benefits of an Invasive Strategy in Non-ST Elevation ACS;Medical Tx for 72-170 hr Then, cath lab n=207;ISAR-COOL Primary Endpoint;Timing of an Invasive Strategy in Non-ST Elevation ACS;Antithrombotic Trialists’ Collaboration. BMJ. 2002;324:71–86.;CURE;CURE CV Death/MI/Stroke, 1 Year;CURE;CURE Major/Life-Threatening Bleeds in the 7 Days After CABG;ACC/AHA ACS Guideline Update;Heparin (UF or LMW) in ACS Without ST Death or MI;FRAXIS (nadroparin; n=2357);CLASS Ia （Ia 级推荐） 一旦出现UA/NSTEMI，需尽快在抗血小板治疗的基础上给予患者抗凝药物 。 介入方案：证据级别A-包括依诺肝素和普通肝素；证据级别B-包括比伐 卢定和戊聚糖钠 保守方案：药物选择可以是依诺肝素、普通肝素（证据级别A）或者戊聚 糖钠（证据级别B），有效性已经确立。 对于选择保守治疗的病人，如果有较高的出血风险，倾向于选择戊聚糖钠 （证据级别B） CLASS IIa （IIa 级推荐） 对于最初选择保守治疗策略的UA/NSTEMI病人，作为抗凝治疗，依诺肝素或者戊聚糖钠要优于普通肝素，除非计划在24小时内进行冠脉搭桥手术 。（证据级别B）;ACC/AHA 2007更新的抗凝治疗指南;ACC/AHA 治疗建议2007;ACCP7指南对LMWH的治疗建议;Rest pain 5 min and ST Δ 0.1 mV or Documented CAD or CK-MB N=132;TIMI - 8: Bivalirudin vs. Placebo in ACS;Beta Blockers;5.6;IIb/IIIa Inhibitors in ACS Patients;Conclusions;UA / NSTEMI: Pharmacological and Mechanical Intervention;Algorithm for Patients with UA/NSTEMI Managed by an Initial Invasive Strategy;Initiate clopidogrel (Class I, LOE: A);Evidence for Primary PCI as Treatment of Choice for STEMI ACS;p=0.0003;Primary, Transfer, Facilitated Rescue PCI for STEMI;Door-To-Balloon (DTB) Time Choice of Reperfusion Therapy in STEMI;Evidence for Pre-Hospital Thrombolysis for Early ( 2 Hour) STEMI;Evidence to support Transfer to PCI Centers from Hospitals without PCI facilities for STEMI ACS;Evidence Against Facilitated PCI for STEMI ACS;Evidence for Res?ue PTCA after failed fibrinolysis (RESCUE I trial);Options for Patients with Prolonged Transfer Times;2006 ESC Guidelines for STEMI;LATE RECANALIZATION OF INFARCT-RELATED ARTERY;A