超過再灌注治療時(shí)間窗的stemi患者的介入治療策略選擇-資料下載頁(yè)
2025-09-19 09:35本頁(yè)面
【導(dǎo)讀】以高齡患者為多；多合并其它疾?。ㄌ?。更傾向于保守治療；當(dāng)?shù)蒯t(yī)療條件相對(duì)不。對(duì)心肌梗死后3-28天梗死相關(guān)血管全閉的穩(wěn)定的高。危病人行PCI治療與藥物治療相比，3年隨訪發(fā)現(xiàn)，盡管復(fù)合終點(diǎn)無差異，但是，PCI與藥物治療相比。再梗的發(fā)生率有增加的趨勢(shì)。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。＞24小時(shí)就診，無癥狀不推薦急診PCI不推薦急診PCI. 將12小時(shí)作為分界點(diǎn)過于武斷（主要來源于溶栓時(shí)。代的研究），PCI相較于溶栓有許多不同點(diǎn)；血栓抽吸裝置的出現(xiàn)為PCI治療提供了更多優(yōu)勢(shì)；自然狀態(tài)的AMI不同于動(dòng)物實(shí)驗(yàn)的單純阻斷血管。即使無缺血癥狀也不能說明一定不存在存活心??；
【正文】 arighed (t) Symptom duration (h) Symptomvarighed (t) Infarktst248。rrelse (% af LV) Linear regression: p R178。= 11 % 20 % p= (321) (735) (n=248) Symptom duration (h) Total occlusion subgroup: Infarct size Infarct size (% of LV) Symptomvarighed (t) Salvage / AAR (%) 57 % 44 % p= (4286) (2373) Linear regression: p= R178。= Total occlusion subgroup: Salvage index (n=154) Symptom duration (h)? Timetotreatment in primary PCI does matter: Infarct size increases and salvage index decreases (”time is muscle”) in the interval 072 hours Conclusions ? Timetotreatment in primary PCI does matter: Infarct size increases and salvage index decreases (”time is muscle”) in the interval 072 hours ? Substantial salvage is observed despite symptom durations of 1272 hours, even when the infarctrelated artery is totally occluded Conclusions ? Timetotreatment in primary PCI does matter: Infarct size increases and salvage index decreases (”time is muscle”) in the interval 072 hours ? Substantial salvage is observed despite symptom durations of 1272 hours, even when the infarctrelated artery is totally occluded ? Lateers should be considered for primary PCI Conclusions 對(duì)鄉(xiāng)村地區(qū)預(yù)期由于長(zhǎng)距離轉(zhuǎn)運(yùn)而造成時(shí)間延誤的 STEMI病人采用藥物 介入治療策略的安全性和有效性研究 結(jié)論 : For STEMI pts facing long delays to a PCI center, halfdose lytic therapy plus immediate transfer for PCI is a safe alternative to primary PCI. 2,634 pts received either primary PCI or halfdose fibrinolytic plus immediate transfer for PCI, depending on distance from PCI center. Larson DM, et al. Eur Heart J. 2020。Epub ahead of print. 30Day Outes Primary PCI (n = 1,763) Pharmaco Invasive (n = 692) P Value Mortality % % Recurrent Ischemia/MI % % TIMI Major Bleeding % % European Heart Journal (2020) 31, 2501–2555 從癥狀開始起 1224小時(shí)，甚至可能至 60小時(shí)的病人，即使疼痛緩解，血流動(dòng)力學(xué)穩(wěn)定，也有可能從早期冠脈造影及可能的 PCI中獲益。 總 結(jié) ?重視心梗后 1272小時(shí)就診的患者，即使沒有癥狀，不說明沒有存活心肌， 急診 PCI治療可能獲益； ?盡可能應(yīng)用血栓抽吸、 IIb/IIIa拮抗劑等手段，減少無復(fù)流現(xiàn)象，挽救更多心肌； ?如果由于轉(zhuǎn)運(yùn)造成時(shí)間延誤，可以采用藥物 介入治療策略以挽救心??； ?急診 PCI隊(duì)伍可能面臨更大的壓力； Thank You!
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