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1、Non-STElevation AcuteCoronarySyndromesPeterBerger,MD ProfessorofMedicineDir.OfInterventionalCardiology DukeUniversityMedicalCenterandDukeClinicalResearchInstituteDurham,NCChinaOctober,20051.7MillionHospitalDischargesAHA.HeartDiseaseandStrokeStatistics—2005UpdateACSSTEMIHospitalDischargesforACSNon-
2、STEACSvsSTEMINSTEACS1.4MillionDischarges/Yr321,000Discharge/YrNSTEACS:KeyThemesNSTEACS:ahighriskpopulation?patientrisk??benefitfromtreatmentwithmedications,aninvasivestrategyInteractionbetweeninvasivestrategyandpharmacologictxAntithromboticscornerstoneoftreatmentAnticoagulants:heparin,LMWH,directt
3、hrombininhibitorsAntiplateletagents:aspirin,IIb/IIIa,ADPinhibitorsBaselineCharacteristicsNSTEACSPatients:RecentRCTsandLargeRegistryQ22003PURSUITCUREGUSTO-IVACSCRUSADECharacteristic(n=9,461)(n=12,562)(n=7,800)(n=5,426)Meanage±SD(yrs)63±1163±1265±1167±14Diabetesmellitus(%)23232233PriorCHF(%)118819Pr
4、iorPCI(%)13---1022PriorCABG(%)1218*820NEJM1998;339:436;NEJM2001;345:494;Lancet2001;357:1915-24*CABGorPTCAAntmanEMetalNEnglJMed1996;335:1342-9360240120020181614121086420Cumulativeprobabilityofdeath>84ml/min51-66ml/min<51ml/minP<0.001,logrank%66-84ml/minAvilesRJetalNEJM2003CreatinineClearanceandMort
5、alityGUSTO4Days360240120020181614121086420Probabilityofdeath,%>1869ng/L237-669ng/L<237ng/LP<0.001,logrank669-1869ng/LJamesSetalCirculation2003NT-proBNPGUSTO4DaysInvasivevs.ConservativeStrategyforACSDeathor(re)-MITrialNPCIConsRITA318107.68.3VINO1316.322.4TACTICS22207.39.5TRUCS1487.616.7FRISCII24511
6、0.414.1MATE2019.96.7VANQUISH92024.012.2Overall7876Fox,Lancet360:743‘03Death/(re)InfarctionRR=0.88,p=0.05Interventionbetter0.10.20.30.50.71.01.52.0Death/(re)-MICP971744-45%ConsInvTACTICS–TIMI18TnTcutpoint=0.01ng/mL(54%ofptTnT+)TroponinT:Death,MI,RehospACS,6MonthsOR=0.52*P<0.001InteractionP<0.001P=N
7、S*n=414n=396n=463n=495FRISCScoreandanInvasiveStrategyScore0-23-45-7n9721051264p0.560.018<0.001RR1.14(0.73-1.77)0.69(0.50-0.94)0.44(0.28-0.69)0510152025303540DeathorMIat12mos,%Strategy:Non-invasiveInvasiveFRISCsco
