PCI围手术期抗凝治疗课件.ppt

PCI围手术期抗凝治疗HarmonizingOutcomeswithRevascularizationandStentsinAMI胸痛发≤12小时STEMI患者（N≥3400*）急诊冠脉造影后再次进行随机化PrimaryPCIStrategy普通肝素+GPIIb/IIIa拮抗剂(阿昔单抗/依替巴肽）比伐卢定单一治疗(±临时GPIIb/IIIa拮抗剂)阿斯匹林，噻吩吡啶（如氯吡格雷）R1:1≥3000例进入随机R1:3金属裸支架TAXUS紫杉醇涂层支架*最终获得3000例支架植入患者临床随访：30天,1年,然后每年1次直至5年HORIZONS-AMI研究MehranRetal.AmHeartJ.2008Jul;156(1):44-56.PCI围手术期抗凝治疗HarmonizingOutcomeswithRevascularizationandStentsinAMIUFH+GPIIb/IIIaN=1802BivalirudinMonotherapyN=1800R1:130天随访率ITT原则分析N=1778(98.7%)N=1777(98.7%)N=1802N=1800???撤出??????失访???91510133602名患者被纳入HORIZONS-AMI研究StoneGW,etal.NEnglJMed.2008May22;358(21):2218-30PCI围手术期抗凝治疗RR=0.99[0.76,1.30]Psup=0.95比伐卢定减少30天总不良临床事件(ITT分析原则)RR=0.60[0.46,0.77]Psup≤0.0001RR=0.76[0.63,0.92]Psup=0.0051?endpoint1?endpointStoneGW,etal.NEnglJMed.2008May22;358(21):2218-30PCI围手术期抗凝治疗比伐卢定减少30天死亡率NumberatriskBivalirudin 1800 1758 1751 1746 1742 1729 1666Heparin+GPIIb/IIIa 1802 1764 1748 1736 1728 1707 1630Death(%)TimeinDays3.1%2.1%HR[95%CI]=0.66[0.44,1.00]P=0.048Heparin+GPIIb/IIIainhibitor(n=1802)Bivalirudinmonotherapy(n=1800)StoneGW,etal.NEnglJMed.2008May22;358(21):2218-30PCI围手术期抗凝治疗比伐卢定减少30天心源性死亡率NumberatriskBivalirudin 1800 1758 1751 1746 1742 1729 1666Heparin+GPIIb/IIIa 1802 1764 1748 1736 1728 1707 1630死亡(%)随访时间（天）2.9%1.8%Heparin+GPIIb/IIIainhibitor(n=1802)Bivalirudinmonotherapy(n=1800)0.3%0.2%CardiacNoncardiacHR[95%CI]=0.62[0.40,0.96]P=0.029StoneGW,etal.NEnglJMed.2008May22;358(21):2218-30PCI围手术期抗凝治疗NumberatriskBivalirudin 1678 1647 1640 1635 1632 1620 1563 Heparin+GPIIb/IIIa 1662 1631 1615 1604 1598 1583 1512 死亡(%)随访时间（天）1.8%Heparin+GPIIb/IIIainhibitor(n=1662)Bivalirudinmonotherapy(n=1678)0.2%0.1%CardiacNoncardiac单纯PCI队列研究也显示：比伐卢定减少30天心源性死亡率2.8%HR[95%CI]=0.63[0.40,0.99]P=0.049St