【新整理】非st段抬高急性冠脈綜合征-閱讀頁
2024-11-20 22:00本頁面
【正文】 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。324:71–86.,OR*,0.5,1.0,1.5,2.0,500–1500 mg 34 19 160–325 mg 19 26 75–150 mg 12 32 75 mg 3 13 Any aspirin 65 23,Antiplatelet Better,Antiplatelet Worse,Aspirin Dose No. of Trials (%),Odds Ratio,0,Aspirin Dose and Events in HighRisk Pts Frequency of CV Death, MI, Stroke,P=0.0001,CURE,CP9995472,Yusuf S et al NEJM 2001。 n=1482) FRAXIS (nadroparin。 n=3171) TIMI IIB (enoxaparin。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。 quality indicator Use in everyone without contraindications,Platelet GP IIb/IIIa Inhibition for NonST ? ACS Primary Endpoint Results from the 5 Major RCTs,All PCI trials 17,393 0.66 8.5 5.6 All ACS trials 24,311 0.89 12.8 11.4 ACS troponin (+) 1,368 0.42 16.3 6.9 ACS PCI 2,311 0.66 14.4 9.6 ACS no PCI 12,685 0.93 14.3 13.3 ACS troponin (–) 2,901 1.05 6.2 6.5,IIb/IIIa MetaAnalysis 30Day Death, MI at 30 Days,CP944328 1,Relative risk Placebo IIb/IIIa No. ratio (%) (%),Chew DP et al: JACC 2000。 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。g /kg/min infusion x 12 hours Abciximab (Reopro) 0.25 mg/kg bolus 0.125 181
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