急性冠脉综合征患者冠脉介入治疗指南-英文.ppt

Guidelines for Coronary Intervention in ACS    Early Risk Stratification in ACS Use of risk-stratification models, such as the TIMI or GRACE risk score or PURSUIT risk model, can be useful to assist in decision making with regard to treatment options in patients with suspected ACS. It is reasonable to remeasure positive biomarkers at 6- to 8-h intervals 2 to 3 times or until levels have peaked, as an index of infarct size and dynamics of necrosis. The TIMI Risk Score and Incidence of Adverse Ischemic Events in Patients with NSTE-ACS Risk Scores B-Type Natriuretic Peptide B-type natriuretic peptide (BNP): new biomarker of considerable interest BNP is a cardiac neurohormone released on ventricular myocyte stretch as proBNP, which is enzymatically cleaved to the N- terminal proBNP (NT-pro-BNP) and, subsequently, to BNP Natriuretic peptides are strong predictors of both short- and long- term mortality in patients with STEMI and UA/NSTEMI Recommend: Measurement of BNP or NT-pro-BNP may be considered to supplement assessment of global risk in patients with suspected ACS (Class IIb, LOE: B) Select Management Strategy: Initial Invasive Versus Initial Conservative Strategy Fragmin during Instability in Coronary Artery Disease (FRISC-2) Patients within 48 h UA/NSTEMI Early inv vs conserv dalteparin vs placebo 3048 patients → dalteparin for 5–7 d → 2457 continued dalteparin/placebo received either inv or conserv rx strategy Meds: ASA, β-blockers unless contraindicated No ↓ death/MI @ 3 mo by dalteparin ↓ Death/MI @ 6 mo, 1 y 5 y for inv strategy ― Benefit confined to men, nonsmokers, and patients with ≥ 2 risk factors Treat Angina with Aggrastat and Determine Cost of Therapy with an Invasive or Conservative Strategy (TACTICS-TIMI-18) 2,220 patients within 24 h UA/NSTEMI Early inv or conserv (selective invasive) strategy Meds: ASA, heparin and tirofiban ↓ Death, MI, and rehosp for an ACS @ 6 mo for inv strategy ― Benefit in medium and high-risk patien