1、AMI StrategyHow to Achieve Door-to-Balloon Times of 90 Minutes and What to Do Next?Aaron Kugelmass, MDDirector, Cardiac Cath LabAssociate Division ChiefHenry Ford HospitalDetroit, Michigan, USAOverview IntroductionThe Argument for Primary PCI Overview of the Henry Ford Program Program SpecificsProce
2、ss Dictates Outcomes Alternative OpportunitiesAcute MI: Introduction 1.1 million people yearly in the US* About 500,000 have STEMI 220,000 die from their AMI 50% of deaths in the first hour Outlook of hospitalized patients better*AHA: 2001 Heart and stroke statisticsAcute MI: Early ManagementReperfu
3、sion Pharmacological (Thrombolysis)FibrinolyticsAntithrombinsPlatelet Inhibitors Mechanical (Direct/Primary PCI) Angioplasty Stent Thrombectomy Combined? Facilitated PCIAcute MI: Direct PCIAdvantages Rapid assessment of anatomy and hemodynamics TIMI-3 flow rates 75-95% in infarct artery Low incidenc
4、e of hemorrhagic stroke Can be done in patients with contraindications for thrombolysis Results superior to thrombolytics in randomized trialsDirect PTCA vs. ThrombolysisPAMI-1N Engl J Med 1993; 328:673-679Primary Angioplasty vs. Thrombolysis: Meta-analysisDeathp=0.02Death+MIp0.01Weaver DW, JAMA 1997;278:2093-2098Primary Angioplasty vs. Thrombolysis: Meta-analysisWeaver DW, JAMA 1997;278:2093-2098PCI vs Lysis Meta AnalysisKeeley E, Lancet 2003; 361: 1320Lytics vs Transfer for PCI: DANAMI
