冠心病治疗 2008精选.pptVIP

PCI for CAD: 2008 Considerations Revascularization Therapy for CAD, Who When ? If Revascularization indicated, PCI or CABG ? If PCI, DES or BMS ? Complex PCI Strategy (STEMI, LM, MVD, Diabetic, Bifurcation CTO) “Treats Patients Not Lesions” Stable Angina : Maximal Medical Therapy, deferred PCI 穩定心絞痛 : 药物治疗後介入 ACS : Early PCI , especially High-Risk Pts 急性冠脈綜合症 : 介入(高危) + 葯物治疗 PCI for CAD: 2008 Considerations Revascularization therapy for CAD, Who When ? If Revascularization indicated, PCI or CABG ? If PCI, DES or BMS ? Complex PCI Strategy (STEMI, LM, MVD, Diabetic, Bifurcation CTO) PCI for CAD: 2008 Considerations Revascularization therapy for CAD, Who When ? If Revascularization indicated, PCI or CABG ? If PCI, DES or BMS ? Complex PCI Strategy (STEMI, LM, MVD, Diabetic, Bifurcation CTO) Efficacy of DESReduced Target Lesion Revascularization PCI for CAD: 2008 Considerations Revascularization therapy for CAD, Who When ? If Revascularization indicated, PCI or CABG ? If PCI, DES or BMS ? Complex PCI Strategy (STEMI, LM, MVD, Diabetic, Bifurcation CTO) When to use DES for PPCI Early onset STEMI High risk of restenosis After Thrombo-aspiration After Pre-dilatation Future of PCI for CAD PCI Milestones: 1977: POBA 1990: BMS 2000: DES 2008: ? Bioabsorbable DES Conclusion Early PCI for ACS but deferred PCI for Stable Angina, unless large reversible ischemic burden present PCI for all who need revascularization except Diabetics, ULM or when where CABG is contraindicated or unavailable Thrombus aspiration followed by stenting ( ? DES) for Primary PCI for eligible STEMI PCI for CTO should not be based only on anatomy Bioabsorbable stents ? Next PCI breakthrough Thank You Kastrati ACC 2008 Clopidogrel 600mg as early as possible could be helpful Abciximab still needed for high-risk pts Facilitation Upstream GP2b3a Inhibitor no clinical benefit over in lab Full-dose fibrinolytics Harmful Half-dose lytic + GP2b3a Inh H