【新整理】非st段抬高急性冠脈綜合征-預(yù)覽頁(yè)
【正文】 743 ‘03,Death/(re)MI,CP97174445,%,TACTICS–TIMI 18,TnT cut point = 0.01 ng/mL (54% of pt TnT +),Troponin T: Death, MI, Rehosp ACS, 6 Months,OR=0.52 *P0.001 Interaction P0.001,P=NS,*,n=414,n=396,n=463,n=495,FRISC Score and an Invasive Strategy,Score 02 34 57 n 972 1051 264 p 0.56 0.018 0.001 RR 1.14 (0.731.77) 0.69 (0.500.94) 0.44 (0.280.69),,0,5,10,15,20,25,30,35,40,Death or MI at 12 mos, % Strategy:,Noninvasive,Invasive,FRISC score Age 65 years Male gender Diabetes mellitus Previous MI STdepression Elevated troponin Elevated Il6 / CRP,Lagerqvist B et al Heart 2004,Benefits of an Invasive Strategy in NonST Elevation ACS,Only shown to reduce death and MI in high risk pts Reduces rehospitalization, angina in many others Shortens hospitalization, may be cost effective What about the optimal timing of an invasive strategy?,Medical Tx for 72170 hr Then, cath lab n=207,Cath lab ?6 hr n=203,ISARCOOL,CP11076554,Neumann FJ et al JAMA 2004,67% had ? troponin, 65% had ST depression,Aspirin 500 mg, 100 mg bid Clopidogrel 600 mg, 75 mg bid Tirofiban 10 mg/kg bolus, 0.10 mg/kg/min infusion Heparin (PTT 6085 seconds),NonST? Acute Coronary Syndrome ? troponin or ST depression n=410,ISARCOOL Primary Endpoint,CP11076552,30day event rate (%),Death amp。 n=1482) FRAXIS (nadroparin。102:11931209,LMWH Better,UFH Better,LMWH versus UFH in UA/NSTEMI Managed Noninvasively: Effect on Death, MI, Recurrent Ischemia,Rest pain 5 min and ST Δ 0.1 mV or Documented CAD or ? CKMB N=132,Heparin 70 U/kg bolus + 15 U/kg/hr infusion,Bivalirudin 0.1 mg/kg bolus + 0.25 mg/kg infusion,TIMI 8: Bivalirudin vs. Placebo in ACS,TIMI 8: Bivalirudin vs. Placebo in ACS,46 wks,7 days,46 wks,7 days,p=0.008,p=0.024,p=NS,p=NS,Direct Thrombin Inhibitors in ACS,CP9997317,Being studied。 probably those with diabetes, marked ST segment shifts Do not recommend their routine administration to all ACS pts in whom a noninvasive strategy is planned,TENACITY Tirofiban Evaluation of Novel Dosing vs. Abciximab with Clopidogrel and Inhibition of Thrombin Study,Intermediate to Highrisk PCI Patients,Aspirin + Highdose Clopidogrel Intenttostent,N ~ 8,000,Tirofiban,Abciximab,Stopped after 383 pts enrolled,TENACITY Study Medication Dosage,Tirofiban (Aggrastat) 25 181
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