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( Class Ⅱ b) 2022: CAPTIM new FU data STEMI randomlization primary PCI (n=421) rtPA TTPCI (n=419) 5000 U IV haprin+250500mg ASA First endpoint: 5year mortality Bonnefoy E et al, European Heart Journal 2022. CAPTIM:TTPCI reduce the 5year mortality Bonnefoy E et al, European Heart Journal 2022. %%0%4%8%12%16%rtPA TTPCI PCI5年全因死亡率Onset 6 hours, P= HR (95% CI,) RR 25% %%0%4%8%12%rtPA TTPCI PCI5年內(nèi)的死亡率Onset 2hours, p= HR (95% CI,) Bonnefoy E et al, European Heart Journal 2022. RR 50% CAPTIM:TTPCI reduce the 5year mortality 2022ESC: NORDISTEMI ? Objective: To pare 2 different strategies after thrombolysis for STEMI in patients with very long transfer times: ? A: Immediate transfer for CAG/PCI ? B: Conservative, ischemiaguided treatment Halvorsen S: Presented in ESC 2022 NORDISTEMI: study design Bonnefoy E et al, European Heart Journal 2022. 300mg + Tenecteplase (TNK) Enoxaparin + Clopidogrel 300mg A: Immediate transfer for CAG/PCI B: Conservative ischemiaguided treatment Acute STEMI 6 hours Expected time delay to PCI 90 min Clinical Oute at 30 days: Conservative Invasive 21% % % 10% Death,reMI,stroke New ischemia RR=() P= (%) Events Death,reMI,stroke) Death % % Bonnefoy E et al, European Heart Journal 2022. RR=() P= STEMI: Drug reperfusion Fibrinolytic SK ↓ Fibrin specific Antiplatelet ASA ↓ GP IIb/IIIa Clopidegrel Anticoagulant UFH ↓ Alternative Agents STEMI長(zhǎng)期雙重抗血小板治療明顯獲益 CLARITY TIMI28 COMMIT/CCS2 ESC 2022: STEMI Guideline GPⅡ b/Ⅲ a inhibitors: ? GPⅡb/Ⅲa inhibitor conbam thrombolysis, the therapeutics is increase, but the bleeding is also increase。 ? 應(yīng)該積極推進(jìn) 規(guī)范的溶栓治療 ,以提高我國急性急性 ST段抬高心梗的再灌注治療的 比例和 成功率 ! 急性 ST段抬高心肌梗死溶栓治療的中國專家共識(shí) (2022年 更新版 ). For AMI patient, the first contact in raral hospital, which strategies for reperfusion: Thrombolysis ? Transfer to PCI ? PRAGUE study 15. 3%7. 4%6. 0%7. 3%05101520 3 h r s 3 12 h r sT im e t o Ran d o m iz at io n30 days MortalityF i b r i n o l y s i sP C Ip = ns p Widimsky et al Eur Heart J 2022。114:671719 Class I ? if onset 3 hours: Door to baloon time (DN) – door to thrombolysis time (DB) : 1 hour, primary PCI is better 1 hour, thrombolysis is better ? if onset 3 hours, primary PCI is better Circulation 2022 August 10。 ESC 2022 STEMI Guidelines ? Onset in 3~ 12 hours, PCI is the better, because of salvaging more ischemic myocardium, and reducing the stroke. ? If no PCI qualification, and have the counterconditions, the patient should be transfer immediately. ? 23 RCT have documented, primary PCI reduce the mortality, reMI, stroke, and preserved the heart function is better vs thrombolysis. Circulation 2022 August 10。 ESC 2022 STEMI Guidelines ? the time of onset present ? STEMI risk score ? risk of thrombolysis ? the time for transfer to PCI cathlab Circulation 2022 August 10。 Shock Resolve the stenosis Reducing the mortality AMI survivor with an improved oute Yusuf S, et al. Circulation. 1990。( Class Ⅱ b) 2022年: CAPTIM最新隨訪結(jié)果 隨機(jī) 5000 U IV肝素 +250500mg阿司匹林 主要終點(diǎn): 5年隨訪中的死亡率 B