冠心病治疗策略的演变课件

冠心病治疗策略的演变冠心病治疗策略的演变冠心病治疗策略的演变冠心病治疗观念的改变NovelChangesinConceptofElderlyCHDTreatmentLuminalstenosistovulnerableplaqueformation从重视管腔狭窄到易损斑块Lipiddeposittoinflammatoryresponse从注意脂质沉积到炎症反应Vulnerableplaquetovulnerablepatient从重视易损斑块到易损病人SingleRFcontroltomulti-RFintervention从单一危险因素控制到多个危险因素联合干预Standardizedtreatmenttoindividualizedtherapy从注重规范化治疗到个体化治疗冠心病治疗观念改变之FirstChangeinConceptofchdtreatmentLuminalstenosisVulnerablePlaque管腔狭窄易损斑块冠心病治疗观念的改变NovelChangesinConceptofElderlyCHDTreatmentLuminalstenosistovulnerableplaqueformation从重视管腔狭窄到易损斑块Lipiddeposittoinflammatoryresponse从注意脂质沉积到炎症反应Vulnerableplaquetovulnerablepatient从重视易损斑块到易损病人SingleRFcontroltomulti-RFintervention从单一危险因素控制到多个危险因素联合干预Standardizedtreatmenttoindividualizedtherapy从注重规范化治疗到个体化治疗冠心病治疗观念改变之FirstChangeinConceptofchdtreatmentLuminalstenosisVulnerablePlaque管腔狭窄易损斑块动脉粥样硬化的传统观念TraditionalConceptofatherosclerosisDegreeofCoronaryStenosisRiskofchd冠脉狭窄程度冠心病严重度急性心梗前的冠脉狭窄程度CoronaryArteryStenosispre-AMI850-70%0>70%ofDiameterStenosis(n=195Falkerelcreston.D9592:657降脂疗法降低心脏事件但并不改变管腔狭窄Lipid-loweringTherapiesDecreaseCardiacEventsbutNotStenosisTrialCholesterolDecreaseCardiaceventdecrease%oChangeinStenosis.%oFATSSTARS0.5±3.6STARS1.5±4.0SCRIP0.3±2.5PLAC10.69LevineGN,KeaneyJFJrVitaJA.CholesterolreductionincardiovasculardiseaEng/JMed,199532:512-5212.PhilbinEFPearsonTA.Howdoeslipid-loweringtherapyrapidlyreduceischemicevents?MyocardIschemia,1994;6:13-18.PittB,ManciniGB,EllisSG,RosmanHS,ParkJ-5,McGovernMEforthePLACIinvestigatorsPravastatin/imitationoftherasckerosisinthecoronaryarteries(PLACI):reductioninatherosclerosisprogressionandclinicalevents.JAmCollardo.199526:113-1139CoronaryArteryStenosisAndCardiacEvents冠脉狭窄与心脏事件Plaquevolumeorseverityofcoronaryarterystenosismaynotbethekeyfactorforinducingcardiacevents.提示:冠脉狭窄并非心血管事件关键原因ConceptofVulnerablePlaque易损斑块概念的提出In1989,Mullerandcolleaguesfirstused"vulnerableplaques"todescriberupture-proneplaquesastheunderlyingcauseofmostclinicalcoronaryevents.首侣易损斑块破裂观念Avulnerableplaqueoftenhasalargelipidpool,athincap,andmacrophage-denseinflammationonorbeneathitssurface+TEVulnerableplaqueruptureordisruptioncausesbleedingintotheplaque,luminalthrombosis,andorvasospasmthatmaycausesuddenflowobstructionandischemicinjury.破裂致血栓形成MullerJ,ToflerG,StoneP.Circadianvariationandtriggersofonsetofacutecardiovasculardisease.Circulation.1989:79:733-743多方位策略演变