nstemi危險(xiǎn)分層和介入策略(ppt34頁(yè))-文庫(kù)吧資料
2025-03-14 18:28本頁(yè)面
【正文】 N=1,593 Delayed N=1,438 HR CI P Major Bleed during initial hospitalization ICH 0 Surg Intervention Retroperitoneal ↓ Hb = 3 g/dL Transfusion ≥ 2 U Mehta SR et al. N Engl J Med 2023。302:94754. 20 UA or NSTEMI 2 of 3 Criteria: Age 60, ischemic EKG Δ or ↑ biomarker AND suitable for revascularization RANDOMIZE* Early Invasive Coronary angiography as soon as possible (no later than 24 hours) followed by PCI or CABG Delayed Invasive Coronary angiography any time 36 hrs followed by PCI or CABG ASA, clopidogrel, GP IIb/IIIa antagonist as per routine practice *Center chose randomization ratio 1:1, 1:2 or 2:1 Early: Delayed Followup at 30 days and 6 months TIMACS研究：對(duì) NSTEACS病人即刻 PCI與 入院后 36小時(shí) PCI進(jìn)行比較 (n=3031) 21 Days Cumulative Hazard 0.02 0 30 60 90 120 150 180 主要 終 點(diǎn)： 6個(gè)月死亡、心梗及中 風(fēng)聯(lián) 合 終 點(diǎn) Early No. at Risk Delayed Early 1438 1328 1269 1254 1234 1229 1211 1593 1484 1413 1398 1391 1382 1363 Delayed HR 95% CI P= Mehta SR et al. N Engl J Med 2023。 98) Delayed Median, IQR, hrs 77 ( 49。302:94754. 18 02468101214161820Death MIUrg RevascUrg PCIUrg CABGRec IschI m m e d i a teD e l a y e d% P= P= P= P= P= P= Montalescot G, et al. JAMA. 2023。302:94754. 16 0 20 40 60 80 1000.000.020.040.060.080.100.120.14T r o p o n i n I ( n g / m L )DensityD i s t r i b u t i o n c u r v e s o f t h e p e a k s v a l u e s o f t r o p o n i n i n t h e i m m e d i a t e a n d d e l a y e d g r o u p si m m e d i a t e g r o u pd e l a y e d g r o u pMedian, IQR () () p = JAMA. 2023。中危 :3~4分 。31(20):250155. 2023歐洲心肌血運(yùn)重建指南早期危險(xiǎn)分層的建議 10 GRACE危險(xiǎn)評(píng)分法 ? 根據(jù)對(duì)住院死亡率和出院后 6個(gè)月死亡率的獨(dú)立預(yù)測(cè)因子來(lái)確定危險(xiǎn)因素，共涉及 9個(gè)變量 11 下載地址： 免費(fèi)軟件 :計(jì)算 GRACE危險(xiǎn)評(píng)分 12 Non STEACS: 院內(nèi)死亡率預(yù)測(cè) Non STEACS: 6個(gè)月院外死亡率預(yù)測(cè) Eagle KA, et al. JAMA 2023。若 GRACE評(píng)分＞ 140，應(yīng)盡快在 24 h內(nèi)行急診造影檢查。20232060 8 極高危病人 至少存在以下一個(gè)特征 中高危病人 至少以下特征之一
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