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1、,急性心肌梗死的溶栓和急诊PCI STEMI：Thrombolytic Therapy and PCI,Southwest Hospital,何国祥 第三军医大学西南医院 重庆市介入心脏病学研究所 Dept. of Cardiology, Southwest Hospital The Thrid Military Medical University Chongqing Institute of Interventional Cardiology,Southwest Hospital,ST-segment elevation myocardial infarction（STEMI）,Trend
2、s for lysis and PCI for STEMI “D to N” and “D to B” PCI vs Fibrinolysis Primary PCI Transfer for Primary PCI Immediate PCI 7. Rescue PCI 8. Facilitated PCI,Southwest Hospital,ST-segment elevation myocardial infarction（STEMI）,Southwest Hospital,Southwest Hospital,Southwest Hospital,ST-segment elevati
3、on myocardial infarction（STEMI）,Southwest Hospital,ST-segment elevation myocardial infarction（STEMI）,Trends for lysis and PCI for STEMI “D to N” and “D to B” PCI vs Fibrinolysis Primary PCI Transfer for Primary PCI Immediate PCI 7. Rescue PCI 8. Facilitated PCI,Southwest Hospital,ST-segment elevatio
4、n myocardial infarction（STEMI）,Southwest Hospital,ST-segment elevation myocardial infarction（STEMI）,Southwest Hospital,Southwest Hospital,Southwest Hospital,ST-segment elevation myocardial infarction（STEMI）,Southwest Hospital,ST-segment elevation myocardial infarction（STEMI）,Southwest Hospital,South
5、west Hospital,Southwest Hospital,STEMI的直接PCI:影响近远期预后的因素,Southwest Hospital,ST-segment elevation myocardial infarction（STEMI）,Trends for lysis and PCI for STEMI “D to N” and “D to B” PCI vs Fibrinolysis Primary PCI Transfer for Primary PCI Immediate PCI 7. Rescue PCI 8. Facilitated PCI,Southwest Hosp
6、ital,Meta-Analysis of 23 Randomized Trials PCI vs Lysis (n=7739),ST-segment elevation myocardial infarction（STEMI）,Southwest Hospital,Southwest Hospital,Southwest Hospital,Southwest Hospital,ST-segment elevation myocardial infarction（STEMI）,Southwest Hospital,ST-segment elevation myocardial infarcti
7、on（STEMI）,Trends for lysis and PCI for STEMI “D to N” and “D to B” PCI vs Fibrinolysis Primary PCI Transfer for Primary PCI Immediate PCI 7. Rescue PCI 8. Facilitated PCI,Southwest Hospital,ST-segment elevation myocardial infarction（STEMI）,Southwest Hospital,ST-segment elevation myocardial infarctio
8、n（STEMI）,Southwest Hospital,ST-segment elevation myocardial infarction（STEMI）,Southwest Hospital,ST-segment elevation myocardial infarction（STEMI）,Southwest Hospital,ST-segment elevation myocardial infarction（STEMI）,Southwest Hospital,Southwest Hospital,Southwest Hospital,ST-segment elevation myocar
9、dial infarction（STEMI）,Southwest Hospital,ST-segment elevation myocardial infarction（STEMI）,Southwest Hospital,ST-segment elevation myocardial infarction（STEMI）,Southwest Hospital,Southwest Hospital,ST-segment elevation myocardial infarction（STEMI）,Trends for lysis and PCI for STEMI “D to N” and “D
10、to B” PCI vs Fibrinolysis Primary PCI Transfer for Primary PCI Immediate PCI 7. Rescue PCI 8. Facilitated PCI,Southwest Hospital,Southwest Hospital,ST-segment elevation myocardial infarction（STEMI）,Southwest Hospital,Southwest Hospital,ST-segment elevation myocardial infarction（STEMI）,Southwest Hosp
11、ital,ST-segment elevation myocardial infarction（STEMI）,Trends for lysis and PCI for STEMI “D to N” and “D to B” PCI vs Fibrinolysis Primary PCI Transfer for Primary PCI Immediate PCI 7. Rescue PCI 8. Facilitated PCI,Southwest Hospital,ST-segment elevation myocardial infarction（STEMI）,Southwest Hospi
12、tal,Southwest Hospital,ST-segment elevation myocardial infarction（STEMI）,Southwest Hospital,Conclusions Immediate transfer for PCI did not improve the primary outcome significantly, but reduced the rate of death, reinfarction,or stroke at 12 months in patients with STEMI, treated with thrombolysis a
13、nd clopidogrel in areas with long transfer distances. (Norwegian Study on District Treatment of ST-Elevation Myocardial Infarction. J Am Coll Cardiol 2010;55:10210,ST-segment elevation myocardial infarction（STEMI）,Southwest Hospital,Lancet 2004; 364: 104553,ST-segment elevation myocardial infarction
14、（STEMI）,Southwest Hospital,Southwest Hospital,Southwest Hospital,Conclusions In patients with STEMI, early post-thrombolysis catheterisation and appropriate intervention is safe and might be preferable to a conservative strategy since it reduces the need for unplanned in-hospital revascularisation,
15、and improves 1-year clinical outcome.,Southwest Hospital,Southwest Hospital,Southwest Hospital,Southwest Hospital,Southwest Hospital,Conclusions Early elective PCI within 48 hours of successful thrombolytic therapy for AMI appeared safe and more beneficial compared with PCI performed later. Am J Car
16、diol 2009;103:13331338,Southwest Hospital,Southwest Hospital,Southwest Hospital,Southwest Hospital,Conclusions The mortality benefit of immediate referral to PCI after pharmacological treatment for STEMI derives from a reduction in the time to reperfusion of patients with failed thrombolysis in need
17、 of rescue PCI. In patients with evidence of successful reperfusion, “elective” PCI within 3 days may be sufficient to reduce the recurrent ischemic events.,Southwest Hospital,Southwest Hospital,ST-segment elevation myocardial infarction（STEMI）,Trends for lysis and PCI for STEMI “D to N” and “D to B
18、” PCI vs Fibrinolysis Primary PCI Transfer for Primary PCI Immediate PCI 7. Rescue PCI 8. Facilitated PCI,Southwest Hospital,Southwest Hospital,Southwest Hospital,Southwest Hospital,Southwest Hospital,Southwest Hospital,ST-segment elevation myocardial infarction（STEMI）,Southwest Hospital,Southwest H
19、ospital,ST-segment elevation myocardial infarction（STEMI）,Trends for lysis and PCI for STEMI “D to N” and “D to B” PCI vs Fibrinolysis Primary PCI Transfer for Primary PCI Immediate PCI 7.Rescue 8.Facilitated PCI,Southwest Hospital,ST-segment elevation myocardial infarction（STEMI）,Southwest Hospital
20、,Southwest Hospital,Lancet 2006; 367: 56978,Southwest Hospital,Southwest Hospital,Southwest Hospital,Southwest Hospital,Southwest Hospital,Southwest Hospital,ST-segment elevation myocardial infarction（STEMI）,Southwest Hospital,ST-segment elevation myocardial infarction（STEMI）,Fig. 1. Organization of
21、 ST-segment elevation myocardial infarction patient pathway describing pre- and in-hospital management and reperfusion strategies within 12 h of first medical contact.,ST-segment elevation myocardial infarction（STEMI）,Welcome to new Chongqing !,Thank you!,ST-segment elevation myocardial infarction（STEMI）,