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1、ST段抬高心肌梗死抗栓治療進展首都醫(yī)科大學附屬北京安貞醫(yī)院心內科RecommendationsforanticoagulantinpatientswithSTEMIundergoingprimaryPCIAnticoagulationisrecommendedforallpatientsinadditiontoantiplatelettherapyduringPCI.IATheanticoagulationisselectedaccordingtobothischaemicandbleedingrisks,andaccordingtotheefficacy–safe
2、typrofileofthechosenagent.ICUnfractionatedheparin:70–100U/kgi.v.boluswhennoGPIIb/IIIainhibitorisplanned50–70U/kgi.v.boluswithGPIIb/IIIainhibitor.ICBivalirudin0.75mg/kgi.v.bolusfollowedbyi.v.infusionof1.75mg/kg/hforupto4hoursaftertheprocedure.IIaAEnoxaparini.v.0.5mg/kgwithorwithoutGPIIb
3、/IIIainhibitor.IIaBContentsIschemicriskscoreandstratificationBleedingriskscoreStrategyThemainanticoagulantchoicesIschemicriskscoreandstratificationWhethermedicaltherapy,PCI,orCABGispreferredshoulddependontherisk–benefitratiosofthesetreatmentstrategies,weightingtherisksofperiprocedurald
4、eath,myocardialinfarctionandstrokeagainstimprovementsinhealth-relatedqualityoflife,aswellaslong-termfreedomfromdeath,myocardialinfarctionorrepeatrevascu-larization.TheHeartTeamshouldtakeintoconsiderationthecoronaryanatomy,disease,ageandcomorbidities,patientpreference,andhospital/operat
5、orexperience.TheEuroSCOREpredictssurgicalmortality.7,8Itisbasedonanolddatasetandhasbeenshowntooverestimatetheriskofmortality,andshouldthereforenolongerbeused.9,10TheEuroSCOREIIisanupdateofthelogisticEuroSCOREmodelandisderivedfromamorecontemporarydatasetbetterreflectingcurrentcardiacsur
6、gicalpractice.11ItsvaluehasbeendemonstratedinspecificcohortsofpatientsundergoingCABG.12Comparedwithitsoriginalversion,theEuroSCOREIImayhaveabetterabilitytopredictmortality.12–14TheSocietyofThoracicSurgeons(STS)scoreisarisk-predictionmodel,validatedinpatientsundergoingcardiacsurgery,wit
7、haspecificmodelforCABGsurgeryandcombinedCABGandvalvesurgery.15,16Itcanbeusedtopredictin-hospitalor30-daymortality(whicheveroccurslast)andin-hospitalmorbidity.TheSYNTAXscore(Table3)wasdevelopedtogradetheanatomicalcomplexityofcoronarylesionsinpatientswithleftmainorthree-vesseldisease,a
