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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 HospitalSouthwest HospitalDept. of Cardiology, Southwest HospitalThe Thrid Military Medical UniversityChongqing Institute of Interventional Cardiology急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwe
2、st Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMISTEMISTEMI）1.1.Trends for Trends for lysislysis and PCI for STEMI and PCI for STEMI2.2.“D to N” and “D to B”
3、“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急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital ST-segment elevation myocardial infarctionST-segme
4、nt elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMISTEMISTEMI）急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital 急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital 急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hosp
5、ital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMISTEMISTEMI）急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital ST-segment elevation myocardial infarctionST-segme
6、nt elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMISTEMISTEMI）1.1.Trends for Trends for lysislysis and PCI for STEMI 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 PCIPrim
7、ary PCI5.5.Transfer for Primary PCITransfer for Primary PCI6.6.Immediate PCIImmediate PCI7. Rescue PCI7. Rescue PCI8. Facilitated PCI急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocard
8、ial infarctionST-segment elevation myocardial infarction（STEMISTEMISTEMISTEMI）急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarctio
9、n（STEMISTEMISTEMISTEMI）急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital 急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital 急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocard
10、ial infarctionST-segment elevation myocardial infarction（STEMISTEMISTEMISTEMI）急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarctio
11、n（STEMISTEMISTEMISTEMI）急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital 急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital 急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest 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急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital ST-segment el
12、evation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMISTEMISTEMI）1.1.Trends for Trends for lysislysis and PCI for STEMI and PCI for STEMI2.2.“D to N” and “D to B” “D to N” and “D to B” 3.P
13、CI vs Fibrinolysis4.4.Primary PCIPrimary PCI5.5.Transfer for Primary PCITransfer for Primary PCI6.6.Immediate PCIImmediate PCI7. Rescue PCI7. Rescue PCI8. Facilitated PCI急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital Meta-Analysis of 23 Randomized Trials Meta-Analysis of 23 Randomized Trials
14、 PCI vs Lysis (n=7739) PCI vs Lysis (n=7739)ST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMISTEMISTEMI）急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital 急性心肌梗死的溶栓和急
15、诊pci英文 Southwest HospitalSouthwest Hospital 急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital 急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation
16、 myocardial infarction（STEMISTEMISTEMISTEMI）急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMISTEMISTEMI）1.1.Trends
17、for Trends for lysislysis and PCI for STEMI 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急性心肌梗死的溶栓和急诊pci英文
18、Southwest HospitalSouthwest Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMISTEMISTEMI）急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital ST-segment elevati
19、on myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMISTEMISTEMI）急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial
20、 infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMISTEMISTEMI）急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST
21、-segment elevation myocardial infarction（STEMISTEMISTEMISTEMI）急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMISTEM
22、ISTEMI）急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital 急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital 急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST
23、-segment elevation myocardial infarction（STEMISTEMISTEMISTEMI）急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMISTEM
24、ISTEMI）急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMISTEMISTEMI）急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Ho
25、spital 急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMISTEMISTEMI）1.1.Trends for Trends for lysislysis and PCI for
26、 STEMI 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急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital
27、急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMISTEMISTEMI）急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital
28、急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMISTEMISTEMI）急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital
29、ST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMISTEMISTEMI）1.1.Trends for Trends for lysislysis and PCI for STEMI and PCI for STEMI2.2.“D to N” and “D to B” “D to N” and
30、 “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急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital ST-segment elevation myocardial infarctionST-segment elevation
31、 myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMISTEMISTEMI）急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital 急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital ST-segment elevation myocardial infarctionST-segment elevation
32、 myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMISTEMISTEMI）急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital ConclusionsConclusionsImmediate transfer for PCI did not improve the primary outcome significantly, but reduced the r
33、ate of death, reinfarction,or stroke 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 infarc
34、tionST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMISTEMISTEMI）急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital Lancet 2004; 364: 104553ST-segment elevation myocardial infarctionST-segment elevation myocar
35、dial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMISTEMISTEMI）急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital 急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital 急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital ConclusionsIn
36、patients with STEMI, early post-thrombolysis catheterisation and 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.急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest
37、 Hospital 急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital 急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital 急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital 急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital Conclusions Early elective PCI within 48 hours of successfulthrombolyt
38、ic therapy for AMI appeared safe and more beneficial compared with PCIperformed later. Am J Cardiol 2009;103:13331338急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital 急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital 急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital 急性心肌梗死的溶栓和急诊pci英文
39、Southwest HospitalSouthwest Hospital ConclusionsThe mortality benefit of immediate referral 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 reperfusi
40、on, “elective” PCI within 3 days may be sufficient to reduce the recurrent ischemic events.急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital 急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elev
41、ation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMISTEMISTEMI）1.1.Trends for Trends for lysislysis and PCI for STEMI 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 P
42、rimary PCI6.6.Immediate PCIImmediate PCI7. Rescue PCI7. Rescue PCI8. Facilitated PCI急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital 急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital 急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital 急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospi
43、tal 急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital 急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMISTEMIST
44、EMI）急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital 急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMISTEMIST
45、EMI）1.1.Trends for Trends for lysislysis and PCI for STEMI 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.Rescue7.Rescue8.Facilitated PCI急性心肌梗死的溶栓和急诊pc
46、i英文 Southwest HospitalSouthwest Hospital ST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMISTEMISTEMI）急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital 急性心肌梗死的溶栓和急诊pc
47、i英文 Southwest HospitalSouthwest Hospital Lancet 2006; 367: 56978急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital 急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital 急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital 急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest Hospital 急性心肌梗死的溶栓和急诊pci英
48、文 Southwest HospitalSouthwest Hospital 急性心肌梗死的溶栓和急诊pci英文 Southwest HospitalSouthwest HospitalST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMISTEMISTEMI）急性心肌梗死的溶栓和急诊pci英文
49、 Southwest HospitalSouthwest HospitalST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMISTEMISTEMI）急性心肌梗死的溶栓和急诊pci英文 Fig. 1. Organization of ST-segment elevation myocardial
50、 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 infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMISTEMISTEMI）急性心肌梗死的溶栓和急诊pci英文Welcome to new Chongqing !Thank you!ST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarctionST-segment elevation myocardial infarction（STEMISTEMISTEMISTEMI）急性心肌梗死的溶栓和急诊pci英文
