急性冠脉综合征2008

1、Unstable AnginaNSTEMINQMIQwMI Myocardial Infarction不稳定斑块稳定斑块Thin fibrous capThrombusThick fibrous capSmooth muscle cellsLipid rich coreandmacrophagesMedia血清标记物血清标记物 心肌肌钙蛋白心肌肌钙蛋白 肌红蛋白肌红蛋白 - CKMB MB同功酶同功酶 cTnI cTnT分子量分子量(KD) 17 23 33 86 86首先出现首先出现(h) 12 24 34 24100%敏感敏感(h) 48 812 812 610峰时间峰时间(h) 48 1

2、024 1024 612持续时间持续时间(d) 0.51.0 510 514 23 0.51.0Reproduced with permission from Antman EM, Cohen M, Bernink PJ, et al. The TIMI risk score for unstable angina/non-ST elevation MI: a method for prognostication and therapeutic decision making. JAMA. 2000;284:835-842. Copyright 2000, American Medical A

3、ssociation. All rights reserved.Reproduced with permission from Antman EM, Cohen M, Bernink PJ, et al. The TIMI risk score for unstable angina/non-ST elevation MI: a method for prognostication and therapeutic decision making. JAMA. 2000;284:835-842. Copyright 2000, American Medical Association. All

4、rights reserved.4.78.313.219.926.240.9010203040500/123456/7Number of Risk FactorsDeath, MI, or Urgent Revascularization (%)天二级预防月32PTTLAMILL-CADRECIFECARELIPIDPAIS24小时8461012 182MIRACL4S6阿托伐他汀普伐他汀辛伐他汀PROVE ITWOSCOPS一级预防ACS氟伐他汀FLORIDA0612PI=placebo; Rx=treatmentShepherd J et al. N Engl J Med. 1995;33

5、3:1301-1307.4S Study Group. Lancet. 1995;345:1274-1275.Sacks FM et al. N Engl J Med. 1996;335:1001-1009.Downs JR et al. JAMA. 1998;279:1615-1622.Tonkin A. Presented at AHA Scientific Sessions, 1997.随访平均随访平均 LDL-C浓度浓度 (mg/dL)05101520253090110130150170190210冠心病事件率冠心病事件率（）（）CARE-RxLIPID-Rx4S-RxCARE-PILIPID-PI4S-PI二级预防二级预防一级预防一级预防WOSCOPS-PIWOSCOPS-RxAFCAPS/TexCAPS-RxAFCAPS/TexCAPS-PI早期应用他汀类早期应用他汀类 ：降脂以外的作用，稳定斑块，预防减少事件降脂以外的作用，稳定斑块，预防减少事件血小板功能血小板功能凝血凝血(PAI-1，纤溶酶，纤溶酶原激活物原激活物1