PCI在2008年进展中地亮点.pptVIP

ARC Proposed Standard Definitions Definite/Confirmed Acute coronary syndrome AND [Angiographic confirmation of thrombus or occlusion OR Pathologic confirmation of acute thrombosis] Probable Unexplained death within 30 days Target vessel MI without angiographic confirmation of thrombosis or other identified culprit lesion Possible Unexplained death after 30 days Stent Thrombosis: FDA Advisory Panel, 8RCT Discontinuation of Anti-platelet Therapy and Risk for ST 不适宜长期双重抗血小板治疗的情况 计划中的非心脏手术 支架血栓形成的高危患者 出血并发症风险增加 高龄，贫血，肾功能衰竭，消化道出血后， 低体重 需长期服口服抗凝剂者 房颤、肺栓塞、机械瓣置换术后 不愿意或不能长期按医嘱服药者 Summary Long-term efficacy of DES is persistent and the safety of DES is confirmed by meta-analysis based on patients level Late stent thrombosis after DES implantation has emerged as a concerning entity Indication for DES stenting Proper dual antiplatelet therapy, at least 1year Technical improvement of DES and new type of DES are emerging and promising Strategy of Bifurcation Lesions Take Home Message Bifurcation stenting requires a meticulous technique with excellent dilation of the side-branch Left Main Coronary Disease: CABG vs PCI Take Home Message Left main stenting is feasible and in the Main-Compare study from Korea appeared very similar to CABG surgery at 3 year follow-up. Interventions for STEMI TRANSFER-AMITrial of Routine ANgioplasty and Stenting after Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction Treatment Medical Therapies TNK Heparin or Enoxaparin in pts ≤ 75 yrs of age ASA 160-325 mg Clopidogrel 300mg bolus (75 mg if 75 years of age) All other meds as per ACC/AHA STEMI guidelines Components of Primary Endpoint Safety Endpoints Take Home Messages High-risk STEMI patients treated with fibrinolysis who undergo PCI within 6 hours have lower rates of adverse ischemic outcomes without significant increase in bleeding risk Transfer should be initiated as soon as possible without awaiting resu