1、 急性心肌梗死的溶栓和急诊急性心肌梗死的溶栓和急诊 PCI STEMI： Thrombolytic Therapy and PCI Southwest Hospital 何国祥 第三军医大学西南医院 重庆市介入心脏病学研究所 Dept. of Cardiology, Southwest Hospital The Thrid Military Medical University Chongqing Institute of Interventional Cardiology Southwest Hospital ST-segment elevation myocardial infarctio
2、n（ STEMI） 1.Trends for lysis and PCI for STEMI 2.“D to N” and “D to B” 3.PCI vs Fibrinolysis 4.Primary PCI 5.Transfer for Primary PCI 6.Immediate PCI 7. Rescue PCI 8. Facilitated PCI Southwest Hospital ST-segment elevation myocardial infarction（ STEMI） Southwest Hospital Southwest Hospital Southwest
3、 Hospital ST-segment elevation myocardial infarction（ STEMI） Southwest Hospital ST-segment elevation myocardial infarction（ STEMI） 1.Trends for lysis and PCI for STEMI 2.“D to N” and “D to B” 3.PCI vs Fibrinolysis 4.Primary PCI 5.Transfer for Primary PCI 6.Immediate PCI 7. Rescue PCI 8. Facilitated
4、PCI Southwest Hospital ST-segment elevation myocardial infarction（ STEMI） Southwest Hospital ST-segment elevation myocardial infarction（ STEMI） Southwest Hospital Southwest Hospital Southwest Hospital ST-segment elevation myocardial infarction（ STEMI） Southwest Hospital ST-segment elevation myocardi
5、al infarction（ STEMI） Southwest Hospital Southwest Hospital Southwest Hospital STEMI的直接 PCI:影响近远期预后的因素 Southwest Hospital ST-segment elevation myocardial infarction（ STEMI） 1.Trends for lysis and PCI for STEMI 2.“D to N” and “D to B” 3.PCI vs Fibrinolysis 4.Primary PCI 5.Transfer for Primary PCI 6.I
6、mmediate PCI 7. Rescue PCI 8. Facilitated PCI Southwest Hospital Meta-Analysis of 23 Randomized Trials PCI vs Lysis (n=7739) ST-segment elevation myocardial infarction（ STEMI） Southwest Hospital Southwest Hospital Southwest Hospital Southwest Hospital ST-segment elevation myocardial infarction（ STEM
7、I） Southwest Hospital ST-segment elevation myocardial infarction（ STEMI） 1.Trends for lysis and PCI for STEMI 2.“D to N” and “D to B” 3.PCI vs Fibrinolysis 4.Primary PCI 5.Transfer for Primary PCI 6.Immediate PCI 7. Rescue PCI 8. Facilitated PCI Southwest Hospital ST-segment elevation myocardial inf
8、arction（ STEMI） Southwest Hospital ST-segment elevation myocardial infarction（ STEMI） Southwest Hospital ST-segment elevation myocardial infarction（ STEMI） Southwest Hospital ST-segment elevation myocardial infarction（ STEMI） Southwest Hospital ST-segment elevation myocardial infarction（ STEMI） Sout
9、hwest Hospital Southwest Hospital Southwest Hospital ST-segment elevation myocardial infarction（ STEMI） Southwest Hospital ST-segment elevation myocardial infarction（ STEMI） Southwest Hospital ST-segment elevation myocardial infarction（ STEMI） Southwest Hospital Southwest Hospital ST-segment elevati
10、on myocardial infarction（ STEMI） 1.Trends for lysis and PCI for STEMI 2.“D to N” and “D to B” 3.PCI vs Fibrinolysis 4.Primary PCI 5.Transfer for Primary PCI 6.Immediate PCI 7. Rescue PCI 8. Facilitated PCI Southwest Hospital Southwest Hospital ST-segment elevation myocardial infarction（ STEMI） South
11、west Hospital Southwest Hospital ST-segment elevation myocardial infarction（ STEMI） Southwest Hospital ST-segment elevation myocardial infarction（ STEMI） 1.Trends for lysis and PCI for STEMI 2.“D to N” and “D to B” 3.PCI vs Fibrinolysis 4.Primary PCI 5.Transfer for Primary PCI 6.Immediate PCI 7. Res
12、cue PCI 8. Facilitated PCI Southwest Hospital ST-segment elevation myocardial infarction（ STEMI） Southwest Hospital Southwest Hospital ST-segment elevation myocardial infarction（ STEMI） Southwest Hospital Conclusions Immediate transfer for PCI did not improve the primary outcome significantly, but r
13、educed the rate of death, reinfarction,or stroke at 12 months in patients with STEMI, treated with thrombolysis and clopidogrel in areas with long transfer distances. (Norwegian Study on District Treatment of ST-Elevation Myocardial Infarction. J Am Coll Cardiol 2010;55:10210 ST-segment elevation my
14、ocardial infarction（ STEMI） Southwest Hospital Lancet 2004; 364: 104553 ST-segment elevation myocardial infarction（ STEMI） Southwest Hospital Southwest Hospital Southwest Hospital Conclusions In patients with STEMI, early post-thrombolysis catheterisation and appropriate intervention is safe and mig
15、ht be preferable to a conservative strategy since it reduces the need for unplanned in-hospital revascularisation, and improves 1-year clinical outcome . Southwest Hospital Southwest Hospital Southwest Hospital Southwest Hospital Southwest Hospital Conclusions Early elective PCI within 48 hours of s
16、uccessful thrombolytic therapy for AMI appeared safe and more beneficial compared with PCI performed later. Am J Cardiol 2009;103:13331338 Southwest Hospital Southwest Hospital Southwest Hospital Southwest Hospital Conclusions The mortality benefit of immediate referral to PCI after pharmacological
17、treatment for STEMI derives from a reduction in the time to reperfusion of patients with failed thrombolysis in need of rescue PCI. In patients with evidence of successful reperfusion, “elective” PCI within 3 days may be sufficient to reduce the recurrent ischemic events. Southwest Hospital Southwes
18、t Hospital ST-segment elevation myocardial infarction（ STEMI） 1.Trends for lysis and PCI for STEMI 2.“D to N” and “D to B” 3.PCI vs Fibrinolysis 4.Primary PCI 5.Transfer for Primary PCI 6.Immediate PCI 7. Rescue PCI 8. Facilitated PCI Southwest Hospital Southwest Hospital Southwest Hospital Southwes
19、t Hospital Southwest Hospital Southwest Hospital ST-segment elevation myocardial infarction（ STEMI） Southwest Hospital Southwest Hospital ST-segment elevation myocardial infarction（ STEMI） 1.Trends for lysis and PCI for STEMI 2.“D to N” and “D to B” 3.PCI vs Fibrinolysis 4.Primary PCI 5.Transfer for
20、 Primary PCI 6.Immediate PCI 7.Rescue 8.Facilitated PCI Southwest Hospital ST-segment elevation myocardial infarction（ STEMI） Southwest Hospital Southwest Hospital Lancet 2006; 367: 56978 Southwest Hospital Southwest Hospital Southwest Hospital Southwest Hospital Southwest Hospital Southwest Hospita
21、l ST-segment elevation myocardial infarction（ STEMI） Southwest Hospital ST-segment elevation myocardial infarction（ STEMI） Fig. 1. Organization of ST-segment elevation myocardial infarction patient pathway describing pre- and in -hospital management and reperfusion strategies within 12 h of first medical contact. ST-segment elevation myocardial infarction（ STEMI） Welcome to new Chongqing ! Thank you! ST-segment elevation myocardial infarction（ STEMI）
