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1、ESC Guidelines for STE-AMI Management - 2003ESC Guidelines for STE-AMI Management - 20031 1The New ESC Guidelines for the Management of ST-Elevation Acute Myocardial InfarctionThe New ESC Guidelines for the Management of ST-Elevation Acute Myocardial InfarctionFrans Van de Werf, MD, PhD, FESC Univer
2、sity of Leuven, BelgiumFrans Van de Werf, MD, PhD, FESC University of Leuven, BelgiumESC Guidelines for STE-AMI Management - 2003ESC Guidelines for STE-AMI Management - 20032 21996 Guidelines for AMI Management1996 Guidelines for AMI ManagementESC Guidelines for STE-AMI Management - 2003ESC Guidelin
3、es for STE-AMI Management - 20033 3Why an update of the 1996 guidelines?Why an update of the 1996 guidelines?Large number of important new trials published and/or presented since 1996:APRICOT-2, ASPECT-2, ASSENT-1, ASSENT-2, ASSENT-3, ASSENT-3 PLUS, CAPTIM, C-PORT, DANAMI-2, GISSI-Prevention, GUSTO-
4、III, GUSTO-IV, GUSTO-V, HERO-2, HOPE, HPS, InTime-2, MADIT-II, PRAGUE-2, WARIS-IILarge number of important new trials published and/or presented since 1996:APRICOT-2, ASPECT-2, ASSENT-1, ASSENT-2, ASSENT-3, ASSENT-3 PLUS, CAPTIM, C-PORT, DANAMI-2, GISSI-Prevention, GUSTO-III, GUSTO-IV, GUSTO-V, HERO
5、-2, HOPE, HPS, InTime-2, MADIT-II, PRAGUE-2, WARIS-IIESC Guidelines for STE-AMI Management - 2003ESC Guidelines for STE-AMI Management - 20034 4Task Force Members 2003Task Force Members 2003 F. Van de Werf, Chairman (Belgium) D. Ardissino (Italy) A. Betriu (Spain) D.V. Cokkinos (Greece) E. Falk (Den
6、mark) K.A.A. Fox (U.K.) D. Julian (U.K.) M. Lengyel (Hungary) F. Van de Werf, Chairman (Belgium) D. Ardissino (Italy) A. Betriu (Spain) D.V. Cokkinos (Greece) E. Falk (Denmark) K.A.A. Fox (U.K.) D. Julian (U.K.) M. Lengyel (Hungary) F.J. Neumann (Germany) W. Ruzyllo (Poland) K. Thygesen (Denmark) S.
7、R. Underwood (U.K.) A. Vahanian (France) F.W.A. Verheugt(The Netherlands) W. Wijns (Belgium)ESC Guidelines for STE-AMI Management - 2003ESC Guidelines for STE-AMI Management - 20035 52003 ESC Guidelines for STE-AMI2003 ESC Guidelines for STE-AMIESC Guidelines for STE-AMI Management - 2003ESC Guideli
8、nes for STE-AMI Management - 20036 6 Selection of patients for fibrinolysis New fibrinolytic agents Primary PCI Use of GP IIb/IIIa antagonists Use of anticoagulants Use of lipid-lowering agents Use of ACE inhibitors Role of imaging Risk assessment Selection of patients for fibrinolysis New fibrinoly
9、tic agents Primary PCI Use of GP IIb/IIIa antagonists Use of anticoagulants Use of lipid-lowering agents Use of ACE inhibitors Role of imaging Risk assessmentESC 2003 Guidelines for STE-AMI ManagementESC 2003 Guidelines for STE-AMI ManagementSections updated:Sections updated:ESC Guidelines for STE-A
10、MI Management - 2003ESC Guidelines for STE-AMI Management - 20037 7Consensus of opinion of the experts and/or small studiesLevel of Evidence CData derived from a single randomised clinical trial or non-randomised studiesLevel of Evidence BData derived from multiple randomised clinical trials or meta
11、-analysesLevel of Evidence A*Use of Class III is discouraged by the ESCEvidence or general agreement that the treatment is not useful/effective and in some cases may be harmful.Class III*Usefulness/efficacy is less well established by evidence/opinion;Class IIbWeight of evidence/opinion is in favour
12、 of usefulness/efficacy;Class IIaConflicting evidence and/or a divergence of opinion about the usefulness/efficacy of the treatment;Class IIEvidence and/or general agreement that a given treatment is beneficial, useful and effective;Class IRecommendations for ROUTINE ManagementESC Guidelines for STE
13、-AMI Management - 2003ESC Guidelines for STE-AMI Management - 20038 8Reperfusion TherapyReperfusion TherapyRecommendationsReperfusion therapy is indicated in all patients with history of chest pain/discomfort of 50% of pts 90 kgBolus fibrinolysis should facilitate pre-hospital administrationNew fibr
14、inolytic agents: Reteplase (r-PA) Dose: 2 x 10 U double bolus 30 min apart Tenecteplase (TNK-tPA) Dose: single bolus 30 mg if 90 kgBolus fibrinolysis should facilitate pre-hospital administrationESC Guidelines for STE-AMI Management - 2003ESC Guidelines for STE-AMI Management - 20031717ESC 2003 Guid
15、elines for STE-AMI ManagementESC 2003 Guidelines for STE-AMI ManagementSelection of patients for fibrinolysis:New guidelines for the elderly (75 y)? NoSelection of patients for fibrinolysis:New guidelines for the elderly (75 y)? NoESC Guidelines for STE-AMI Management - 2003ESC Guidelines for STE-AM
16、I Management - 200318183.44.67.28.913.516.124.325.305101520253075 y, ST or BBB, 4 hours after symptom onset) a more fibrin-specific agent such as tenecteplase or alteplase is preferred Choice of fibrinolytic agent depends on individual assessment of benefit and risk, availability and costESC Guidelines for STE-AMI Management - 2003ESC Guidelines for STE-AMI Manageme
