超過再灌注治療時(shí)間窗的stemi患者的介入治療策略選擇-wenkub
2022-10-09 09:35:48 本頁(yè)面
【正文】 1977。56: 786794 40min 3 hours 24 hours 96 hours Time Is Muscle, Muscle Is Life JAMA. 2020。355:2395–2407. Primary Endpoint of death, reinfarction, NYHA class IV heart failure (% patients) Hazard Ratio , p= OAT Trial: Primary Component Endpoints N Engl J Med 2020。 ?對(duì) PCI再梗率有增加的趨勢(shì)的一個(gè)解釋是，可能是栓塞造成心肌損害和損害了側(cè)枝血流所致。293:28652872. BRAVE2 試驗(yàn) : 總結(jié) ?對(duì)于心梗 1248小時(shí) 的無(wú)癥狀患者，急診 PCI手術(shù)相較于藥物保守治療能明顯減少梗死心肌范圍； ?在 30天臨床終點(diǎn)事件方面（死亡、再發(fā)心梗、卒中），急診 PCI手術(shù)與藥物保守治療相比無(wú)差別； ?造影發(fā)現(xiàn)，這些患者中 TIMI 0血流僅占 27%，其余73%存在前向血流或側(cè)支循環(huán)。117:296329. Background ? Primary PCI is remended for the treatment of STEMI in patients presenting with symptoms for less than 12 hours Antman EM et al., AHA/ACC STEMI guidelines 2020: Circulation 2020。152:11331139 Background ? BRAVE2 is the only trial on primary angioplasty vs. medical therapy in STEMIpatients with symptoms for 1248 hours on admission Schomig A et al., JAMA 2020。152:11331139 ? Salvage index (% of risk area salvaged): Primary PCI vs. Medical therapy: p Background 44% 23% ? To evaluate if the 12hour limit is a relevant cutoff point for offering primary angioplasty Aim ? Late presenters (1272 h) do not achieve myocardial salvage after primary angioplasty and therefore develop larger final infarct sizes than early presenters (12 h) Hypothesis ? Symptom duration was defined as time from onset of symptoms to first balloon inflation = paintoballoon interval Definition of symptom duration Myocardial scintigraphy before primary PCI: Myocardial scintigraphy 30 days later: Salvage = 465 = 41% of LV myocardium Salvage index = 41/46 = 89% of area at risk Area at risk = 46% Infarct size = 5% Method: Myocardial scintigraphy 1) Ndrepepa G, J Nucl Med 2020。 10%: n=200 1272 h: Infarct size = 20177。 10 Diabetes (%) 9 4 Hypertension (%) 32 31 Hypercholesterolaemia (%) 19 9 Previous AMI (%) 7 0 * Median BMI (kg / m178。= (n=262) Salvage / AAR (%) Symptomvarighed (t) Symptom duration (h) Symptomvarighed (t) Infarktst248。Epub ahead of print. 30Day Outes Primary PCI (n = 1,763) Pharmaco Invasive (n = 692) P Value Mortality % % Recurrent Ischemia/MI % % TIMI Major Bleeding %
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