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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急性心肌梗死的溶栓和急诊急性心肌梗死的溶栓和急诊PCIPCISTEMISTEMI：T Thrombolytic Therapy and PCI Southwest Hospital何国祥何国祥第三军医大学西南医院第三军医大学西南医院重庆市介入心脏病学研究所重庆市介入心脏病学研究所Dept. of Cardiology, Southwest HospitalThe Thrid Military Medical UniversityChongqing Institute of Interventional Cardiology Southwest
2、Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMI）1.1.Trends for lysis and PCI for STEMITrends for lysis and PCI for STEMI2.2.“D to N” and “D to B” “D to N” and “D to B” 3.PCI vs Fibrinolysis4.4.Primary PCIPrimary PCI5.5.Transfer for Primary PCI
3、Transfer for Primary PCI6.6.Immediate PCIImmediate PCI7. Rescue PCI7. Rescue PCI8. Facilitated PCI Southwest Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMI） Southwest Hospital Southwest Hospital Southwest Hospital ST-segment elevation myocard
4、ial infarctionST-segment elevation myocardial infarction（STEMISTEMI） Southwest Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMI）1.1.Trends for lysis and PCI for STEMITrends for lysis and PCI for STEMI2.2.“D to N” and “D to B” “D to N” and “D to
5、 B” 3.PCI vs Fibrinolysis4.4.Primary PCIPrimary PCI5.5.Transfer for Primary PCITransfer for Primary PCI6.6.Immediate PCIImmediate PCI7. Rescue PCI7. Rescue PCI8. Facilitated PCI Southwest Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMI） Southw
6、est Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMI） Southwest Hospital Southwest Hospital Southwest Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMI） Southwest Hospital ST-segment elevat
7、ion myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMI） Southwest Hospital Southwest Hospital Southwest Hospital STEMISTEMI的直接的直接PCI:PCI:影响近远期预后的因素影响近远期预后的因素 Southwest Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMI）1.1
8、.Trends for lysis and PCI for STEMITrends for lysis and PCI for STEMI2.2.“D to N” and “D to B” “D to N” and “D to B” 3.PCI vs Fibrinolysis4.4.Primary PCIPrimary PCI5.5.Transfer for Primary PCITransfer for Primary PCI6.6.Immediate PCIImmediate PCI7. Rescue PCI7. Rescue PCI8. Facilitated PCI Southwest
9、 Hospital Meta-Analysis of 23 Randomized Trials Meta-Analysis of 23 Randomized Trials PCI vs Lysis (n=7739) PCI vs Lysis (n=7739)ST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMI） Southwest Hospital Southwest Hospital Southwest Hospital Southwest Hospita
10、l ST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMI） Southwest Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMI）1.1.Trends for lysis and PCI for STEMITrends for lysis and PCI for STEMI2.2.“D to N” a
11、nd “D to B” “D to N” and “D to B” 3.PCI vs Fibrinolysis4.4.Primary PCIPrimary PCI5.5.Transfer for Primary PCITransfer for Primary PCI6.6.Immediate PCIImmediate PCI7. Rescue PCI7. Rescue PCI8. Facilitated PCI Southwest Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial
12、 infarction（STEMISTEMI） Southwest Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMI） Southwest Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMI） Southwest Hospital ST-segment elevation myoc
13、ardial infarctionST-segment elevation myocardial infarction（STEMISTEMI） Southwest Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMI） Southwest Hospital Southwest Hospital Southwest Hospital ST-segment elevation myocardial infarctionST-segment el
14、evation myocardial infarction（STEMISTEMI） Southwest Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMI） Southwest Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMI） Southwest Hospital Southwe
15、st Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMI）1.1.Trends for lysis and PCI for STEMITrends for lysis and PCI for STEMI2.2.“D to N” and “D to B” “D to N” and “D to B” 3.PCI vs Fibrinolysis4.4.Primary PCIPrimary PCI5.5.Transfer for Primary
16、PCITransfer for Primary PCI6.6.Immediate PCIImmediate PCI7. Rescue PCI7. Rescue PCI8. Facilitated PCI Southwest Hospital Southwest Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMI） Southwest Hospital Southwest Hospital ST-segment elevation myoc
17、ardial infarctionST-segment elevation myocardial infarction（STEMISTEMI） Southwest Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMI）1.1.Trends for lysis and PCI for STEMITrends for lysis and PCI for STEMI2.2.“D to N” and “D to B” “D to N” and “D
18、 to B” 3.PCI vs Fibrinolysis4.4.Primary PCIPrimary PCI5.5.Transfer for Primary PCITransfer for Primary PCI6.6.Immediate PCIImmediate PCI7. Rescue PCI7. Rescue PCI8. Facilitated PCI Southwest Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMI） Sou
19、thwest Hospital Southwest Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMI） Southwest Hospital ConclusionsConclusionsImmediate transfer for PCI did not improve the primary outcome significantly, but reduced the rate of death, reinfarction,or st
20、roke at 12 months in patients with STEMI, treated with thrombolysis and clopidogrel in areas with longtransfer distances. (Norwegian Study on District Treatment of ST-Elevation Myocardial Infarction.J Am Coll Cardiol 2010;55:10210ST-segment elevation myocardial infarctionST-segment elevation myocard
21、ial infarction（STEMISTEMI） Southwest Hospital Lancet 2004; 364: 104553ST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMI） Southwest Hospital Southwest Hospital Southwest Hospital ConclusionsIn patients with STEMI, early post-thrombolysis catheterisation a
22、nd appropriate intervention is safeand might be preferable to a conservative strategy since it reduces the need for unplanned in-hospitalrevascularisation, and improves 1-year clinical outcome. Southwest Hospital Southwest Hospital Southwest Hospital Southwest Hospital Southwest Hospital Conclusions
23、 Early elective PCI within 48 hours of successfulthrombolytic therapy for AMI appeared safe and more beneficial compared with PCIperformed later. Am J Cardiol 2009;103:13331338 Southwest Hospital Southwest Hospital Southwest Hospital Southwest Hospital ConclusionsThe mortality benefit of immediate r
24、eferral to PCI after pharmacological treatment for STEMIderives 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
25、events. Southwest Hospital Southwest Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMI）1.1.Trends for lysis and PCI for STEMITrends for lysis and PCI for STEMI2.2.“D to N” and “D to B” “D to N” and “D to B” 3.PCI vs Fibrinolysis4.4.Primary PCIPr
26、imary PCI5.5.Transfer for Primary PCITransfer for Primary PCI6.6.Immediate PCIImmediate PCI7. Rescue PCI7. Rescue PCI8. Facilitated PCI Southwest Hospital Southwest Hospital Southwest Hospital Southwest Hospital Southwest Hospital Southwest Hospital ST-segment elevation myocardial infarctionST-segme
27、nt elevation myocardial infarction（STEMISTEMI） Southwest Hospital Southwest Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMI）1.1.Trends for lysis and PCI for STEMITrends for lysis and PCI for STEMI2.2.“D to N” and “D to B” “D to N” and “D to B”
28、 3.PCI vs Fibrinolysis4.4.Primary PCIPrimary PCI5.5.Transfer for Primary PCITransfer for Primary PCI6.6.Immediate PCIImmediate PCI7.Rescue7.Rescue8.Facilitated PCI Southwest Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMI） Southwest Hospital S
29、outhwest Hospital Lancet 2006; 367: 56978 Southwest Hospital Southwest Hospital Southwest Hospital Southwest Hospital Southwest Hospital Southwest HospitalST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMI） Southwest HospitalST-segment elevation myocardia
30、l infarctionST-segment elevation myocardial infarction（STEMISTEMI） 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 infarctionST-segment elevation myocardial infarction（STEMISTEMI）Welcome to new Chongqing !Thank you!ST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMI）
