急性冠脉综合征评估及危险分层

TIMI Risk Score For UA/NSTEMI
• Age >65 years • >3CAD Risk Factors D/MI/Urg Revasc (%) • Prior Stenosis >50 % • ST deviation • >2 Anginal events <24 hours • ASA in last 7 days • Elev Cardiac Markers (CK-MB or troponin) 50 40 30 19.9 20 10 0 0/1 2 3 4 5 Number of Risk Factors 32.0 29.3 13.0 6/7 3.4 4.7 8.3 13.2
STEMI with fibrinolytics T-wave inversion
TIMI Risk Score for UA/NSTEMI: 7 Independent Predictors
• Aged ≥65 years • ≥3 CAD risk factors • Prior CAD (stenosis >50%) • Aspirin in last 7 days
Troponin I (TnI), C-Reactive Protein (CRP), and B-type Natriuretic Peptide (BNP) as Determinants of 30-Day Mortality Risks in Acute Coronary Ischemia: A Multimarker Approach
OPUS-TIMI 16 6
30-Day Mortality Relative Risk
6
TACTICS-TIMI 18 14 12
P=.014
P<.001
13
5 4 3 2 1 1 0
67 150 155 78
3.5
10 8 5.7
1.8
6 4 2 0 1
504 717
2.1
324 90
0
1 2 3 No. of Elevated Biomarkers
Acute Coronary Syndromes
Biblioteka Baidu
Evaluation and Risk Stratification
New Terminology in ACS
Plaque Rupture
Stable Angina Unstable Angina Non– Q-wave MI Q-wave MI
Old term
Progressive mechanical obstruction
Dynamic obstruction Inflammation/ infection
Braunwald E. Circulation. 1998;98:2219-2222.
Secondary UA (b MVO2)
GUSTO IIb: Correlation of 6-Month Mortality With Baseline ECG Findings in Patients With ACS
0
1 2 3 No. of Elevated Biomarkers
Sabatine M, et al. Circulation. 2002;105:1760-1763. (with permission)
Braunwald Etiologic Classification of UA
Nonocclusive thrombus on pre-existing plaque
• >2 anginal events in ≤24 hours
• ST deviation
• Elevated cardiac markers (CK-MB or troponin)
TIMI, thrombosis in myocardial infarction; UA, unstable angina; NSTEMI, non–ST-segment elevation myocardial infarction; CAD, coronary artery disease. Antman EM, et al. JAMA. 2000;284:835-842.
New term Atherothrombosis
Daysweeks
UA/NSTEMI Minuteshours
STEMI
Antithrombotic Therapy
Thrombolysis Primary PCI
ACS, acute coronary syndrome; MI, myocardial infarction; UA, unstable angina; NSTEMI, non–ST-segment elevation myocardial infarction; STEMI, ST-segment elevation myocardial infarction; PCI, percutaneous coronary intervention. Cannon CP. J Thromb Thrombolysis. 1995;2:205-218.
10 ST ACS Cumulative Mortality (%) 8 6 4 2 0 0 30 60 90 120 150 180 Days From Randomization
GUSTO, Global Use of Strategies To Open Occluded Arteries in Acute Coronary Syndromes; ECG, electrocardiogram; ACS, acute coronary syndrome; STEMI, ST-segment elevation myocardial infarction. Savonitto S, et al. JAMA. 1999;281:707-713. (with permission)
C Statistic=0.65 c2 trend P<.001
40.9
26.2
Population (%): 4.3
17.3