SPEED研究PPT课件.ppt

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1、GUSTO-IVPilotTrialRationaleforCombinationTherapyinAMIEnhanceIncidenceandSpeedofReperfusionReducedMortalitySaferTherapy-LessICbleedFacilitateEarlyPercutaneousInterventionsSPEEDACC1999:OralPresentationRationaleforCombinationTherapyinAMIImprovedReperfusionOnly40-50%achievenormalperfusion(

2、TIMIgrade3flow)withfibrinolytictherapyaloneReducedMortality30%1-yearmortalityamongtheelderly(>75years)inGUSTO-IIIACC1999:OralPresentationSPEEDRationaleforCombinationTherapyinAMIFacilitateEarlyPercutaneousInterventionsImprovedmortalitywithprimaryPCIislimitedtohospitalswhereprocedureand

3、expertiseisavailableReducedICHRates21%increaseinICbleedfromGUSTO-ItoGUSTO-IIIwitht-PASPEEDACC1999:OralPresentationOverviewofTrialsofLow-DoseLysisandGPIIb/IIIaInhibitors*bolus0.25mg/kg;infusion0.125mg/kg/minx12hCriteriaAge18to75Symptoms<12hours>18yearsoldSymptoms<6hoursTIMI-14SPEED/GUSTO

4、IVAMIPilott-PA,SK,orReteplase+Reteplase+Abciximab*withAbciximab*withHeparin60U/kg30U/kgHeparin60U/kg40U/kgTIMIgrade3flowat90minutesTIMIgrade3flowat60-90minutes(avg.was62min)Rescueonly“Encouraged”-FacilitatedPCICombinationTherapiesStudied1°EndpointPCIControlArm(s)Acceleratedt-PAand10U+10

5、UReteplaseStandardReteplase10U+10USPEEDACC1999:OralPresentation8%18%23%32%Goldetal10minCirc.1997;95:1755-59GRAPE45minJACC1999;33:1528-32SPEED60minEHJ1999;20:616(#3336)TIMI-1490minCirc.1999;99:2720-32AbilityofAbciximabtoCauseDethrombosisTIMIGrade3flow25%50%StudyTime0SPEEDDoseConfirmation

6、ProtocolAcuteMISTelevationSymptomduration<6hrs.1:1Randomizationr-PA10+10UHeparin70U/kgAbciximabstandarddoser-PA5+5UHeparin60U/kg/40U/kg60-90MinuteAngiographyPTCA+StentasindicatedAdministeredintheEDSPEEDACC1999:OralPresentationDoseEscalationandConfirmationDoseEscalationControlAbciximabAl

7、onen=63Controlr-PA10U+10Un=109ExperimentalAbciximabAbciximab+r-PA+r-PA5U+5Un=16660Uheparinn=76SPEEDDoseConfirmationTotalAbciximab+r-PA5U+5U+60UHeparin,n=116ExperimentalAbciximabAbciximab+r-PA5U+5U+r-PA5U+5U60UHeparin40UHeparinn=40n=76ACC1999;OralPresentationDoseConfirmationAcu