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,非ST段抬高性急性冠脉综征的PCI策略研究,RITA-3-results,interventionconservativeRR(95%CI)p,n=895n=915,4-Month,D/MI/Angina86(9.6%)133(14.5%)0.66(0.51-0.85)0.001,1-year,D/MI68(7.6%)76(8.3%)0.91(0.67-1.25)0.58,Symptoms of angina were improved and use of antianginal medications reduced with the interventional strategy(p0.0001),FRISC-II 2 years follow-up,JACC 2002.40:1902-14,invasive conservative,RR(95%CI)P,Mortality(%)3.7 5.40.68(0.47-0.98)0.038,MI(%)9.2 12.70.72(0.57-0.91)0.005,D/MI(%)12.1 16.30.74(0.61-0.09)0.003,After the first year,there was no difference in mortality between the two groups,fewer MIs in invasive group.,Number of D/MIs within 1 year,Invasive,Conservative,RITA 3,68/895(7.6%),76/915(8.3%),VINO,4/64(6.3%),15/67(22.4%),TACTICS-TIMI18,81/1114(7.3%),105/1106(9.5%),TRUCS,6/76(7.6%),12/72(16.7%),FRISC II,127/1219(10.4%),174/1234(14.1%),MATE,11/111(9.9%),6/90(6.7%),VANQWISH,111/462(24.0%),85/458(18.6%),TIMI IIIB,52/484(10.8%),62/509(12.2%),Combined risk ratio 0.88(95%CI 0.78-0.99),0.1,0.5,1.0,2.0,10.0,早期侵入治疗优于早期保守治疗,这些试验比较些什么?,早期介入治疗与早期保守治疗？,早期介入策略与早期保守策略？,非ST断抬高性急性冠脉综合的介入治疗,是早期介入策略获益！,非ST断抬高性急性冠脉综合的介入策略,是早期介入策略获益！,早期介入策略如何获益？,UA&NSTEMI,Early invasive vs.early conservative strategies,Early invasive,:,Early coronary arteriography followed by revascularization as indicated by arteriographic findings,Early conservative,:,Catheterization,and if indicated,revascularization,only in the event of failure of medical therapy,6-month Mortality for Acute Coronary Syndromes,T-wave inversionACS,ST,ACS,Granger CB et al.,J Am Coll Cardiol.,1998;31:79A.,%Cumulative mortality at 6 months,ST,MI with fibrinolytics,2457 patients with ACS(follow-up 6 months),Early Invasive,Strategies,-FRISC,Lancet 1999,Vol354,04/05:我们的策略是否有所改变？,ICTUS研究对我们的启示,Class I:,一、无严重合并症,合并以下高危因素,早期介入治疗:,1 抗缺血治疗中,反复休息时或轻微活动时胸痛/缺血,2 TnT 或TnI升高,3 新出现ST段压低,4 反复胸痛/缺血,伴CHF症状,S3奔马律,肺水肿,MR,5 非创伤性负荷试验高危发现,非ST段抬高性ACS早期介入干预时机-,AHA/ACC指南（2002）,Class I:,6 LV收缩功能降低(EF,.40,负荷试验,非低危,低危,药物治疗,反复缺血症状,心衰,严重心律失常,EF.40,早期介入策略,早期保守策略,ACS:院内治疗,UA/NSTEMI:血运重建术策略,心导管术,药物治疗、,PCI 或 CABG,1 支或,2支病变,PCI 或 CABG,否,CABG,心衰或糖尿病,CABG,是,查胸痛原因,无,3支或,2支(伴LAD,近端)病变,冠心病,有,左主干病变,是,无,小结,早期介入策略优于早期保守策略,早期介入策略的意义在于通过冠脉造影深化危险分层,早期介入策略使中危和高危病人获益,THANK YOU!,Early invasive,vs.,early conservative strategies,Early invasive:,early coronary arteriography followed by revascularization as indicated by arteriographic findings,Early conservative:,catheterization,and if indicated,revascularization,only in the event of failure of medical therapy,UA&NSTEMI,Benefit of Intervention,7.6,8.3,9.6,14.5,0,5,10,15,Patients(%),Conservative(n=915),Death/MI,at 1 year,Death/MI/RA,at 4 months,P,=0.001,RR 0.66 0.510.85,P,=NS,RR,risk ratio,Intervention(n=895),
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