血小板糖蛋白IIbIIIa受体拮抗剂在介入非介入患者中的应用教程.pptVIP

This slide highlights the spectrum of ACS. 大量循证医学研究证实血小板GPIIb/IIIa受体拮抗剂能显著改善ACS和PCI患者的临床预后 With the notable exception of GUSTO IV, most of these studies trend toward better results with the use of GP IIb/IIIa inhibitors.1 1. Boersma E, Harrington R, Moliterno D, White H, Theroux P, Van de Werf F, de Torbal A, Armstrong P, Wallentin L, Wilcox R, Simes J, Califf R, Topol E, Simoons M. Platelet glycoprotein IIb/IIIa inhibitors in acute coronary syndromes: a meta-analysis of all major randomised clinical trials. Lancet. 2002;359:189-198. This slide demonstrates that the totality of data on GP IIb/IIIa inhibitors demonstrates a 21% reduction of mortality in patients with ACS undergoing PCI.1 1. Karvouni E, Katritsis D, Ioannidis J. Intravenous glycoprotein IIb/IIIa receptor antagonists reduce mortality after percutaneous coronary interventions. J Am Coll Cardiol. 2003;41:26-32. This slide demonstrates all of the trials to date that have studied GP IIb/IIIa inhibitors in patients undergoing PCI, and includes MI trials as well. With respect to mortality, a 27% survival benefit has been demonstrated with the use of GP IIb/IIIa inhibitors.1 1. Kong D, Hasselblad V, Harrington R, White H, Tcheng J, Kandzari D, Topol E, Califf R. Meta-analysis of survival with platelet glycoprotein IIb/IIIa antagonists for percutaneous coronary intervention. Am J Cardiol. 2003;92:651-655. 建议水平的定义： Ⅰ级：一般认为给予的治疗是有益的、有用的和有效的； Ⅱ级：关于治疗的有用或有效性的观点存在分歧； Ⅱａ级：多数支持给予的治疗是有益的、有用的和有效的； Ⅱｂ级：少数支持给予的治疗是有益的、有用的和有效的。 证据水平的重新定义： Ａ：证据来自多个对照、随机化、有足够影响力的临床研究，其临床主要终点有适当的时间间隔； Ｂ：证据来自单个对照、随机化、有足够影响力的临床研究，其临床主要终点有适当的时间间隔； Ｃ：证据来自对照、随机化临床研究或非对照研究的次级终点或亚组分析、注册研究、荟萃分析及小样本研究，也可以是专家的一致意见。 血小板糖蛋白IIb/IIIa受体拮抗剂在介入/非介入患者中的应用 浙江大学医学院附属第二医院 心脏中心 王建安 基本原理 分子结构 适应症和循证医学 结论 三类 GPIIb/IIIa受体拮抗剂的化学结构 STEMI Clinical finding EKG Serum markers Risk assessment Non-cardiacchest pain Stableangina UA NSTEMI Negative Positive ST-T wave changes S