急诊PCI的若干问题.ppt

急诊PCI的若干问题 Endothelialprogenitorcell EPC capturingstentsHighdoseGPIIb IIIainhibitorspre hospitalizationManualthrombusaspiration TA duringPPCIPredictorsofstentthrombosisafterPPCI 急诊PCI的若干问题 Randomization 50GenousTM 50CrCo 6 monthclinical angio IVUSFU GENIUS STEMITrial 2007 8 9 Singlecenterprospective ASA100mg day clopidogrel75mg day30daysGPIIb IIIainhibitorsandthromboaspirationatthediscretionofthephysician PresentedbyDr PavelCervinkaatACC 09 i2 Orlando FL GENIUS STEMITrial6 monthclinicaloutcome PresentedbyDr PavelCervinkaatACC 09 i2 Orlando FL GENIUS STEMITrialConclusions TheuseofEPCcapturestentsinthesettingofSTEMIisfeasible safe RateofMACEat6 monthFUwassignificantlyhigherinGenousTMgroupthanCrCostents WarrisomeistherateoflatestentthrombosisinEPCscapturestentgroup Largerrandomizedtrialsaremandatory PresentedbyDr PavelCervinkaatACC 09 i2 Orlando FL 直接PCI患者院前与导管室应用大剂量替罗非班的比较ON TIME 2研究AGIR 2研究 Prospective multicentre placebo controlled randomisedSTEMI30min 24hrs5000UFH 500mgASA 600mgClopidogrel Angiogram Tirofiban Placebo Transportation PCIcentre Angiogram Tirofibanprovisional Tirofibancont d ON TIME 2oneyrfollow up n 9842006 6 2007 11 PPCI Bolus 25 g kg 0 15 g kg mininfusion Follow up ON TIME 2 ChristianW Hammetal Conclusions Highdosetirofibanontopofclopidogrel 600mg intheprehospitalsettingissafePre Hospitalinitiationoftirofiban HDB improvesSTresolutionbefore afterprimaryPCINoincreaseinbleedingriskImprovesoutcomeofprimaryPCIforAMIStrongtrendtoreducedmortalitycontinuesover1yearfollow upInpatientsundergoingprimaryPCImortalityissignificantlylower Highestefficacyinelderly 65yrs inKillipclass 2andinearlypresenters ON TIME 2 ChristianW Hammetal MICU Patientcall STEMIundergoingprimaryPCI STEMI20min 12h600mgclopidogrel250mgaspirinUFH60U kg Tirofiban25 g kgbolus 0 15ug kgivgtt Angiography Angiography Pre hospital MICUtransportation Cathlab RandomizeOpenLabel MedicalDispatcher Tirofiban25 g kgbolus 0 15ug kgivgtt AGIR2 n 156 n 156 PPCI EricBonnefoyetal AGIR2 ResultsandConclusion Theresultsdonotsupportthenecessitytoinitiatetirofibanadministrationinpre hospitalsettings EricBonnefoyetal 急诊PCI血栓抽吸装置的应用Manualthrombusaspiration TA duringPPCI Erythrocyte richthrombiPlatelet fibrin richthrombiCombinedthrombiEdematouscomponentsAtheroscleroticcomponents YANhongbingetal TAPASand1 yearfollow up VlaarP etal Lancet2008 371 1915 20 SvilaasT etal NEnglJ2008 358 557 67 6FExportaspirationcatheterintention to treattrialRoutineutilizationofTAn 535forTAn 536forconventionalPPCIFollow upfor1yr mortality Ameta analysisofadjunctivethrombectomyandembolicprotectiondevicesinSTEMI 1996 200830randomizedtrialsn 6415patients 12hnativevesselSTEMIEndpoints AllcausemortalityMACEStroke BavryAA etal EuropeanHeartJ 2008 29 2989 3001 6month 5month 4month 13trialsn 3026 5trialsn 934 12trialsn 2442 12hSTEMITIMI0 1n 49successfulaspirationwithvisiblematerialDIVERCEandZEEK YANhongbingetal Plaquematerial Removingplaquematerialsfromtheculpritlesionisbeneficial ShouldTAberoutinelyperformedinTIMI2 3patients Needstrials Arethereanydifferencesofdevicesoperabilityandclinicalimpactsamongdifferenttypeaspirationcatheters YANhongbingetal ChinMedJ2009 122 6 648 654 Frequencyofdual wires ClinicalimpactsofDiverCEvsZEEK YANhongbingetal ChinMedJ2009 122 6 648 654 AMI直接PCI支架血栓的预测因素 HORIZONS AMI试验 Nolimitationsfordrug elutingstentsinSTEMIpatients TCT2008 TranscatheterCardiovascularTherapeutics20thAnnualScientificSymposiumOctober12 17 2008 Washington DC Endpoints IndependentPredictorsofST CoxModel AcuteST SubacuteST LateST Conclusions Acute subacute lateSTappeartoberelatedtodifferentfactorsthemostimportantpredictorsofacute subacuteSTevents Pharmacologicaltherapy vesselflow lesioncharacteristics number lengthofstentsthemostimportantpredictorsoflateSTevents Patientrelatedfactorsincludingcigarettesmoking priorMIThetypeofstentimplanted DESvs BMS wasnotrelatedtoSTduringanytimeintervalupto1 yearSTwithin1 yearoccurredwithsimilarfrequencyinpatientstreatedwithUFH GPI bivaliru