不稳定型心绞痛和非ST段抬高心梗的治疗
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Braunwald E, et al. J Am Coll Cardiol. 2000;36:970-1062.
Aspirin in Acute Coronary Syndromes
Unstable Angina
Acute MI
*P<.0001 Death or MI
*P=.003 Reocclusion
Aspirin in Acute Coronary Syndromes
Primary
Stable
Prevention
Angina
UA/NSTEMI
*P<.0001 MI
*P=.0003 MI
*P=.012 Death or MI
*P=.008 Death or MI
2.5 2.2
15 12.9
15 12.9
15
11.9
2
1.5
1.3* 10
10
10
6.2*
1
5
3.9* 5
5
3.3*
0.5
Patients (%)
0 Placebo ASA
0
0
0
Placebo ASA
Placebo ASA
Placebo ASA
N= 11034 11037
155
178
279
276
118
121
MI, myocardial infarction; ASA, acetylsalicylic acid; RISC, Research on InStability in Coronary artery disease; ISIS-2, Second International Study of Infarct Survival. PHS. N Engl J Med. 1989;321:129-35. Ridker PM, et al. AJC. 1991;114:835-839. Cairns JA, et al. N Engl J Med. 1985;313:1369-1375. Theroux P, et al. N Engl J Med. 1988;319:1105-1111.
UA, unstable angina; NSTEMI, non-ST-segment elevation myocardial infarction; ECG, electrocardiogram; ACE, angiotensin-converting enzyme. Braunwald E, et al. J Am Coll Cardiol. 2000;36:970-1062.
• Target therapy: more aggressive treatment in higher-risk patients
• Anti-ischemic, antithrombotic therapy
• Invasive vs conservative strategy
• Discharge planning (risk factor modification and long-term medical therapy)
8587 8600
8587
ASA 8600
MI, myocardial infarction; ASA, acetylsalicylic acid; RISC, Research on InStability in Coronary artery disease. RISC Group. Lancet. 1990;336:827-830. Roux S, et al. J Am Coll Cardiol. 1992;19:671-677. ISIS-2. Lancet. 1988;2:349-360.
*P=.012 MI
*P<.001 Death
20
17.1
30
25.0
15 20
10
6.5*
10 5
11.0*
4
3.3
3
2
1
15பைடு நூலகம்
11.8
10
9.4*
1.9*
5
Patients (%)
0 Placebo
N= 397
ASA 399
0 Placebo 513
ASA 419
0 Placebo ASA 0 Placebo
ACC/AHA, American College of Cardiology/American Heart Association; UA, unstable angina; NSTEMI, non–ST-segment elevation myocardial infarction. Braunwald E, et al. J Am Col. Cardiol. 2000;36:970-1062.
ACC/AHA Class I Recommendations for
Antithrombotic Therapy*
Possible ACS
Likely/Definite ACS
Definite ACS With Invasive Strategy (Catheterization/PCI) or High Risk (IIa)*
Acute Coronary Syndromes: Management of UA/NSTEMI
Overview of 2003 Updates to the ACC/AHA Guideline for UA/NSTEMI
• Assess likelihood of CAD
• Risk stratification
Aspirin
Aspirin +
SQ LMWH* or
IV Heparin
Clopidogrel
Aspirin +
IV Heparin +
IV Platelet GP IIb/IIIa Antagonist
Clopidogrel
* Class IIa: enoxaparin preferred over UFH unless CABG planned within 24 hours.
Acute Management of UA/NSTEMI
Anti-Ischemic Therapy • Oxygen, bed rest, ECG monitoring • Nitroglycerin • -Blockers • ACE inhibitors
Antithrombotic Therapy • Antiplatelet therapy • Anticoagulant therapy
ACC, American College of Cardiology; AHA, American Heart association; ACS, acute coronary syndrome; PCI, percutaneous coronary intervention; SQLMWH, subcutaneous low molecular-weight heparin; IV, intravenous.
Aspirin in Acute Coronary Syndromes
Unstable Angina
Acute MI
*P<.0001 Death or MI
*P=.003 Reocclusion
Aspirin in Acute Coronary Syndromes
Primary
Stable
Prevention
Angina
UA/NSTEMI
*P<.0001 MI
*P=.0003 MI
*P=.012 Death or MI
*P=.008 Death or MI
2.5 2.2
15 12.9
15 12.9
15
11.9
2
1.5
1.3* 10
10
10
6.2*
1
5
3.9* 5
5
3.3*
0.5
Patients (%)
0 Placebo ASA
0
0
0
Placebo ASA
Placebo ASA
Placebo ASA
N= 11034 11037
155
178
279
276
118
121
MI, myocardial infarction; ASA, acetylsalicylic acid; RISC, Research on InStability in Coronary artery disease; ISIS-2, Second International Study of Infarct Survival. PHS. N Engl J Med. 1989;321:129-35. Ridker PM, et al. AJC. 1991;114:835-839. Cairns JA, et al. N Engl J Med. 1985;313:1369-1375. Theroux P, et al. N Engl J Med. 1988;319:1105-1111.
UA, unstable angina; NSTEMI, non-ST-segment elevation myocardial infarction; ECG, electrocardiogram; ACE, angiotensin-converting enzyme. Braunwald E, et al. J Am Coll Cardiol. 2000;36:970-1062.
• Target therapy: more aggressive treatment in higher-risk patients
• Anti-ischemic, antithrombotic therapy
• Invasive vs conservative strategy
• Discharge planning (risk factor modification and long-term medical therapy)
8587 8600
8587
ASA 8600
MI, myocardial infarction; ASA, acetylsalicylic acid; RISC, Research on InStability in Coronary artery disease. RISC Group. Lancet. 1990;336:827-830. Roux S, et al. J Am Coll Cardiol. 1992;19:671-677. ISIS-2. Lancet. 1988;2:349-360.
*P=.012 MI
*P<.001 Death
20
17.1
30
25.0
15 20
10
6.5*
10 5
11.0*
4
3.3
3
2
1
15பைடு நூலகம்
11.8
10
9.4*
1.9*
5
Patients (%)
0 Placebo
N= 397
ASA 399
0 Placebo 513
ASA 419
0 Placebo ASA 0 Placebo
ACC/AHA, American College of Cardiology/American Heart Association; UA, unstable angina; NSTEMI, non–ST-segment elevation myocardial infarction. Braunwald E, et al. J Am Col. Cardiol. 2000;36:970-1062.
ACC/AHA Class I Recommendations for
Antithrombotic Therapy*
Possible ACS
Likely/Definite ACS
Definite ACS With Invasive Strategy (Catheterization/PCI) or High Risk (IIa)*
Acute Coronary Syndromes: Management of UA/NSTEMI
Overview of 2003 Updates to the ACC/AHA Guideline for UA/NSTEMI
• Assess likelihood of CAD
• Risk stratification
Aspirin
Aspirin +
SQ LMWH* or
IV Heparin
Clopidogrel
Aspirin +
IV Heparin +
IV Platelet GP IIb/IIIa Antagonist
Clopidogrel
* Class IIa: enoxaparin preferred over UFH unless CABG planned within 24 hours.
Acute Management of UA/NSTEMI
Anti-Ischemic Therapy • Oxygen, bed rest, ECG monitoring • Nitroglycerin • -Blockers • ACE inhibitors
Antithrombotic Therapy • Antiplatelet therapy • Anticoagulant therapy
ACC, American College of Cardiology; AHA, American Heart association; ACS, acute coronary syndrome; PCI, percutaneous coronary intervention; SQLMWH, subcutaneous low molecular-weight heparin; IV, intravenous.