STEMI再灌注治疗策略进展.pptVIP

具PCI条件医院的再灌注治疗 CLASS I STEMI患者直接PCI，应在缺血症状发作持续时间少于12小时内执行。证据：A 溶栓治疗的禁忌证STEMI患者，直接PCI应在缺血症状不到12小时执行。不论FMC的时间是否延迟。证据：B STEMI伴有心源性休克或急性严重心衰患者，应直接PCI。不论MI发病的持续时间是否被延迟。证据：B CLASS IIa 如果有临床和/或心电图证据持续缺血症状发作12至24小时， STEMI患者直接PCI是合理的。证据：B CLASS III: HARM 血流动力学稳定STEMI患者，直接PCI治疗过程中对非梗死动脉行PCI。 证据：B DIDO时间与院内死亡率的关系 Wang TY et al. JAMA 2011;305:2540-2547 绿色通道的概念 绿色通道是指医院急诊对于急危重症患者所开放的高效快捷的服务流程。绿色通道的建设是为了进一步为抢救患者争取时间，提高急危重症患者的抢救成功率。 绿色通道的要旨：急、畅、效 STEMI的绿色通道流程关键要素 1 患者自行就诊 120急救中心 院内急诊 一键启动 进入DSA 绿色通道住院 院前和入院短期内快速确诊 STEMI的绿色通道流程关键要素 2 患者自行就诊 120急救中心 院内急诊 一键启动 进入DSA 绿色通道住院 院前和入院短期内快速确诊 快速反应团队 STEMI的绿色通道流程关键要素 3 患者自行就诊 120急救中心 院内急诊 一键启动 进入DSA 绿色通道住院 院前和入院短期内快速确诊 快速反应团队 良好的管理机制 谢 谢 * * USIC:美国资讯中心（United States information Center） Transfer for Primary Angioplasty Versus Immediate Thrombolysis in Acute Myocardial Infarction A Meta-Analysis M. Dalby, MD; A. Bouzamondo, MD; P. Lechat, MD; G. Montalescot, MD, PhD Background—The benefit of primary percutaneous coronary intervention (PCI) over thrombolysis has been clearly demonstrated in acute myocardial infarction (AMI). However, the best therapeutic strategy for a patient with AMI presenting to acute care services without catheterization facilities remains under debate. Our objective was to gather all available information from clinical trials comparing transfer of patients experiencing AMI for angioplasty versus immediate thrombolysis. Methods and Results—We performed a meta-analysis of all data available from published randomized trials and from presentations in scientific sessions of major cardiology congresses comparing the 2 strategies. The primary end point was the combined criteria (CC) of death/reinfarction/stroke as defined in each trial. Relative risk (RR) evaluated the treatment effect. We identified 6 clinical trials including 3750 patients. Transfer time was always 3 hours. The CC was significantly reduced by 42% (95% confidence interval [CI] 29% to 53%, P0.001) in the group transferred for primary PCI compared w