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1、高危AMI患者PCI治疗策略探讨,温州医学院附属第一医院心内科 李晟,急性心肌梗死合并低血压,体检仔细 床旁心超 急诊PCI前常规心影摄片 漂浮导管,Intra-Aortic Balloon Pump,IABP：非外科心脏干预死亡率,European Heart Journal (2003) 24, 17631770,OR 95% CI =1.72， 1.51, 1.95 P 0.001,Benchmark 注册研究,IABP：心源性休克死亡率,心源性休克 ： 调整OR 95%CI =1.54, 1.27, 1.87 P 0.001,European Heart Journal (2003)
2、24, 17631770,Benchmark 注册研究,预防性应用：IABP 插入早于介入,European Heart Journal (2003) 24, 17631770,Benchmark 注册研究,IABP适应症与插入特征,严重出血*：穿刺部位,血栓负荷重,防治,GpIIb/IIIa受体拮抗剂。,Glycoprotein IIb/IIIa Inhibitors,It is reasonable to start treatment with abciximab as early as possible before primary PCI (with or without stent
3、ing) in patients with STEMI.,Treatment with tirofiban or eptifibatide may be considered before primary PCI (with or without stenting) in patients with STEMI.,Time after Bolus (minutes),15,30,45,60,120,0,60,80,100,Abciximab,Tirofiban 10 g/kg bolus,Tirofiban 20 g/kg bolus,Tirofiban 25 g/kg bolus,85%,I
4、nhibition of Maximal Aggregation (%) Induced by 20 M of ADP,阿昔单抗与不同负荷剂量替罗非班,Schneider D, et al. Am J Cardiol. 2003;91:334-336.,血管造影终点,TIMI 血流分级,TIMI 灌注分级,TMPG=TIMI myocardial perfusion grade. Danzi B, et al. Am J Cardiol. 2004;94:35-39.,50 45 40 35 30 25 20 15 10 5 0,P=1.0,Pre,Post,Pre,Post,Abciximab,Tirofiban,Number of patients,TIMI 3 TIMI 2 TIMI 0-1,50 45 40 35 30 25 20 15 10 5 0,Pre,Post,Pre,Post,Abciximab,Tirofiban,Number of patients,TMPG 3 TMPG 2 TMPG 0-1,P=0.65,使用远端保护装置。,远端保护装置的临床研究,直接支架,合并肾功能不全,减少造影剂的使用 造影剂选用 补液(注意心功能） 漂浮导管使用,谢谢,