急性心肌梗塞战略.ppt

AMI StrategyHow to Achieve Door-to-Balloon Times of 90 Minutes and What to Do Next?
Aaron Kugelmass, MD
Director, Cardiac Cath Lab
Associate Division Chief
Henry Ford Hospital
Detroit, Michigan, USA
Overview
Introduction
The Argument for Primary PCI
Overview of the Henry Ford Program
Program Specifics
Process Dictates es
Alternative Opportunities
Acute MI: Introduction
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 statistics
Acute MI: Early ManagementReperfusion
Pharmacological (Thrombolysis)
Fibrinolytics
Antithrombins
Platelet Inhibitors
Mechanical (Direct/Primary PCI)
Angioplasty
Stent
bined
? Facilitated PCI
Acute MI: Direct PCIAdvantages
Rapid assessment of anatomy and hemodynamics
TIMI-3 flow rates 75-95% in infarct artery
Low incidence of hemorrhagic stroke
Can be done in patients with contraindications for thrombolysis
Results superior to thrombolytics in randomized trials
Direct PTCA vs. ThrombolysisPAMI-1
N Engl J Med 1993; 328:673-679
Primary Angioplasty vs. Thrombolysis: Meta-analysis
Death
p=
Death+MI
p<
Weaver DW, JAMA 1997;278:2093-2098
Primary Angioplasty vs. Thrombolysis: Meta-analysis
Weaver DW, JAMA 1997;278:2093-2098
PCI vs Lysis Meta Analysis
Keeley E, Lancet 2003; 361: 13–20
Lytics vs Transfer for PCI: DANAMI