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1、不稳定型心绞痛和非ST段抬高心梗的治疗Overviewof2003Updatestothe ACC/AHAGuidelineforUA/NSTEMIAssesslikelihoodofCADRiskstratificationTargettherapy:moreaggressivetreatmentin higher-riskpatientsAnti-ischemic,antithrombotictherapyInvasivevsconservativestrategyDischargeplanning(riskfactormodificationa
2、nd long-termmedicaltherapy)ACC/AHA,AmericanCollegeofCardiology/AmericanHeartAssociation;UA,unstableangina; NSTEMI,non–ST-segmentelevationmyocardialinfarction. BraunwaldE,etal.JAmCol.Cardiol.2000;36:970-1062.AcuteManagementofUA/NSTEMIAnti-IschemicTherapyOxygen,bedrest,ECGmonitor
3、ingNitroglycerin-BlockersACEinhibitorsUA,unstableangina;NSTEMI,non-ST-segmentelevationmyocardialinfarction;ECG,electrocardiogram;ACE,angiotensin-convertingenzyme.BraunwaldE,etal.JAmCollCardiol.2000;36:970-1062.AntithromboticTherapyAntiplatelettherapyAnticoagulanttherapyIndirec
4、tComparisonsofASADosesonVascularEventsinHigh-RiskPatients*Oddsreduction.TreatmenteffectP<.0001.ASA,acetylsalicylicacid.AdaptedwithpermissionfromBMJPublishingGroup.AntithromboticTrialists’Collaboration.BMJ.2002;324:71-86.0.51.01.52.0500-1500mg3419160-325mg192675-150mg1232<75mg31
5、3Anyaspirin6523AntiplateletBetterAntiplateletWorseAspirinDoseNo.ofTrials(%)OddsRatio0OR*BRAVO:BleedingByASAdoseTopolEJ,etal.Circulation.2003;108:399-406.(withpermission)OutcomesbyAspirinDoseinPlaceboStudyDrugPatientsLowDose, 75-162mg/d (n=2410)HigherDose, >162mg/d (n=2179)Prima
6、ryendpoint16.418.6Death,MI,stroke6.26.1Death2.81.7MI2.02.1Stroke2.12.8Urgenthospitalcare9.510.6Urgentresuscitation7.310.0Internalbleeding2.43.3Anybleeding11.115.4Transfusion1.02.0Clopidogrel+ASA†(N=6259)Placebo+ASA*(N=6303)CURE:MajorBleedingat1yearbyASADose<100mg(N=5320)1.9%3.0
7、%100-199mg(N=3109)2.8%3.4%>200mg(N=4110)3.7%4.9%Pvaluefortrend.0001.0009*P=.0001.†P=.0009.AdaptedfromPetersRJG,etal.Circulation.2003;108:1682-1687.ASADoseRR:Death/MIASAAlone68/655=10.4%Heparin+ASA55/698=7.9%BBBBBBB0.1110SummaryRelativeRisk0.67(0.44-0.1.02)TherouxRISCCohen1990AT
8、ACSHoldrightGurfinkelComparisonofHeparin+ASAvsASAAlone
