《急性st段抬高型心肌梗死诊断和治疗指南》2019版更新解读-PPT文档资料

险的关系。
2021/6/10
Terkelsen CJ，et al. JAMA. 2019;304(7):763-771.
仅供医疗专业人士参考
欧美指南一致强调STEMI救治时间前移： 从D2B到FMC
2019 ESC STEMI指南1
• Management—including both diagnosis and treatment—of AMI starts at the point of first medical contact (FMC), defined as the point at which the patient is either initially assessed by a paramedic or physician or other medical personnel in the pre-hospital setting, or the patient arrives at the hospital emergency department— and therefore often in the outpatient setting.
– 4b型：支架血栓引起的MI
– 5型：CABG相关MI
与2019版指南的不同之处： 4a型中原来基线cTn正常的患者在PCI后 cTn升高>3×ULN提高到了>5×ULN
• 中华2医0学21会/6心/1血0管病学分会。中华心血管病杂志，2019，43（5）：380-393
• 中华医学会心血管病学分会。中华心血管病杂志，2019，38（8）：675-690
院前系统延迟 19% HR(95%CI)：1.19(1.11-1.27)；P&I)：1.22(1.15-1.29)；P<0.001
治疗延迟
5.4%
HR(95%CI)：1.054(1.029-1.080)；P<0.001
历史性随访研究，数据来自丹麦医疗注册，入选6209例经紧急医疗服务系统（EMS）转运且行直接PCI治疗的STEMI患者，评估系统延迟和死亡风
仅供医疗专业人士参考
院前延迟和门-球延迟显著增加STEMI死亡风险
症状发作
每延迟1h死亡率增加风险
呼叫EMS
到达PCI中心
直接PCI
患者延迟 4.2% 运输延迟
HR(95%CI)：1.042(1.014-1.071)；P=0.003
门-球延迟 13%
HR(95%CI)：1.13(1.048-1.22)；P=0.002
• 对于拨打911的患者，直接护理始于FMC。EMS人员负责获得院前心电图，作出诊断，激 活系统，并且决定运送病人到有PCI能力或无PCI能力的医院。
2019 ESC EACTS心肌血运重建指南3
• Delays in the timely implementation of reperfusion therapy are key issues in the management of STEMI, since the greatest benefit gained from reperfusion therapy occurs within the first 2–3 hours of symptom onset. The total ischaemic time, between symptom onset and provision of reperfusion therapy (either starting fibrinolysis or mechanical reperfusion by primary PCI), is probably the most important factor. The aim is to provide optimal care while minimizing delays, in order to improve clinical outcomes.
• AMI的管理（包括诊断和治疗）始于首次医疗接触（FMC），定义为院前由护理人员或医 师或其他医务人员对患者进行初始评估时，或患者到达医院急诊室时。
2019 ACCF/AHA STEMI指南2
• For patients who call 9-1-1, direct care begins with FMC, defined as the time at which the EMS provider arrives at the patient’s side. EMS personnel should be accountable for obtaining a prehospital ECG, making the diagnosis, activating the system, and deciding whether to transport the patient to a PCI-capable or non–PCIcapable hospital.
《急性ST段抬高型心肌梗死诊断和治疗指南》 2019版更新解读
2021/6/10
任晖 安康市中心医院
仅供医疗专业人士参考
新指南有关MI的分型
• 依据第三版“MI全球定义”将MI分为5型：
– 1型：自发性MI
指南主要阐述1型MI的诊断和治疗
– 2型：继发于心肌氧供需失衡的MI
– 3型：心脏性猝死
– 4a型：PCI治疗相关的MI
• The reduction of first-medical-contact-to-balloon (FMCTB) time—defined as the time from the (first) medical/hospital door to the time of primary PCI—relies on efficient coordination of care between first medical contact or referral hospitals, the emergency medical service (EMS), and the receiving hospitals.