1、Guidelines for Coronary Intervention in ACS Michael KY LeeQueen Elizabeth Hospital李耿 渊 香港伊丽莎白医院 SCC 2008Division of CardiologyDepartment of MedicineACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/NonST-Elevation Myocardial InfarctionHospitalizations in the U.S. Due to ACS
2、Acute Coronary Syndromes*1.57 Million Hospital Admissions - ACSUA/NSTEMI STEMI1.24 million Admissions per year0.33 million Admissions per year*Primary and secondary diagnoses. About 0.57 million NSTEMI and 0.67 million UA.Heart Disease and Stroke Statistics 2007 Update. Circulation 2007; 115:69171.P
3、rimary PCI for STEMISTEMI patients presenting to a hospital with PCI capability should be treated with primary PCI within 90 min of first medical contact as a systems goal. STEMI patients presenting to a hospital without PCI capability, and who cannot be transferred to a PCI center and undergo PCI w
4、ithin 90 min of first medical contact, should be treated with fibrinolytic therapy within 30 min of hospital presentation as a systems goal, unless fibrinolytic therapy is contraindicated.I IIa IIbIIII IIa IIbIIIA strategy of coronary angiography with intent toperform PCI (or emergency CABG) isrecom
5、mended in patients who have receivedfibrinolytic therapy and have:a. Cardiogenic shock in patients 75 years who are suitable candidates for revascularizationb. Severe congestive heart failure and/or pulmonary edema (Killip class III)c. Hemodynamically compromising ventricular arrhythmias.I IIa IIbII
6、II IIa IIbIIII IIa IIbIIIRescue PCI for STEMIEarly Risk Stratification in ACSUse of risk-stratification models, such as the TIMI or GRACE risk score or PURSUIT risk model, can be useful to assist in decision making with regard to treatment options in patients with suspected ACS. It is reasonable to
7、remeasure positive biomarkers at 6- to 8-h intervals 2 to 3 times or until levels have peaked, as an index of infarct size and dynamics of necrosis.I IIa IIb IIIGRACE = Global Registry of Acute Coronary Events; PURSUIT = Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy; TIMI = Thrombolysis In Myocardial Infarction. I IIa IIb III
