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AHA/ACC更新STEMI患者直接PCI治疗指南

2015-10-27 大鹏 译 医学论坛网

STEMI患者直接PCI治疗指南
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近日，美国心脏学会/美国心脏病学会(AHA/ACC)公布了最新的ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入治疗(PCI)指南修改意见【点此可下载英文原文】。全文发表于《美国心脏病学会杂志》(Journal of the American College of Cardiology)。指南集中修改的地方主要有两处，以下为与旧指南对比的更新建议。 一、罪犯血管——单一病变vs多支

近日，美国心脏学会/美国心脏病学会(AHA/ACC)公布了最新的ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入治疗(PCI)指南修改意见【点此可下载英文原文】。全文发表于《美国心脏病学会杂志》(Journal of the American College of Cardiology)。指南集中修改的地方主要有两处，以下为与旧指南对比的更新建议。

一、罪犯血管——单一病变vs多支病变

2013年指南内容

2015年修订后指南内容

变化

若STEMI患者血流动力学稳定，不推荐直接PCI手术在非梗死相关动脉进行相关干预（推荐级别Ⅲ，证据等级B）。

对于存在多支病变且血流动力学稳定的特定STEMI患者，无论直接PCI或计划手术阶段，均可考虑在非梗死相关动脉进行PCI治疗（推荐级别Ⅱb，证据等级B-R）。

将推荐级别Ⅲ上调至Ⅱb，同时新指南放宽了手术时间窗选择，并纳入了多支病变。

二、血栓抽吸

2013年指南内容

2015年修订后指南内容

变化

直接PCI可考虑手动血栓抽吸治疗（推荐级别Ⅱa，证据等级B）。

1.在接受直接PCI治疗的患者群体，择期血栓抽吸与急救血栓抽吸的有效性尚缺乏足够的证据（推荐级别Ⅱb，证据等级C-LD）。

2.直接PCI前常规血栓抽吸无效（推荐级别Ⅲ，证据等级A）。

微调择期血栓抽吸与急救血栓抽吸的推荐等级，并加入了一项新的推荐，否定了直接PCI前常规血栓抽吸这一治疗方案。

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  1. 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style='color:#2F92EE;'>#STEMI患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16785, encryptionId=74bd16e850c, topicName=STEMI患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=48732500158, createdName=12498c32m68暂无昵称, createdTime=Thu Apr 14 19:19:00 CST 2016, time=2016-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=101743, encodeId=1403101e4387, content=继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Sat Aug 20 18:09:00 CST 2016, time=2016-08-20, status=1, ipAttribution=), 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10:41:00 CST 2016, time=2016-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1934787, encodeId=09f81934e87be, content=<a href='/topic/show?id=1072646328c' target=_blank style='color:#2F92EE;'>#治疗指南#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64632, encryptionId=1072646328c, topicName=治疗指南)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6732482, createdName=w984445tii, createdTime=Thu Nov 26 00:19:00 CST 2015, time=2015-11-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1749117, encodeId=00981e4911767, content=<a href='/topic/show?id=843ee2425a1' target=_blank style='color:#2F92EE;'>#直接PCI#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72425, encryptionId=843ee2425a1, topicName=直接PCI)], attachment=null, 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    2017-02-26 ylzr123

    不错的指南，为我们探讨研究提供了方针，给点个赞了！

    0

  2. 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    2016-12-18 ylzr123

    很好，不错的指南资料，值得拥有值得收藏，值得探究。给自己学习探究提供方便。点个赞！

    0

  3. 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authenticateStatus=null, createdAvatar=null, createdBy=cef136235391, createdName=xuyu, createdTime=Tue Oct 04 16:19:00 CST 2016, time=2016-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=75224, encodeId=ac1ae5224a9, content=可以, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/07/08/e29a8e183b56a54a182b51012b36874c.jpg, createdBy=7fa61707564, createdName=Frankenstein, createdTime=Sat Apr 02 11:28:00 CST 2016, time=2016-04-02, status=1, ipAttribution=)]
    2016-11-29 ylzr123

    很好，不错的指南资料，值得拥有值得收藏，值得探究。给自己学习探究提供方便。点个赞！

    0

  4. 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style='color:#2F92EE;'>#STEMI患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16785, encryptionId=74bd16e850c, topicName=STEMI患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=48732500158, createdName=12498c32m68暂无昵称, createdTime=Thu Apr 14 19:19:00 CST 2016, time=2016-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=101743, encodeId=1403101e4387, content=继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Sat Aug 20 18:09:00 CST 2016, time=2016-08-20, status=1, ipAttribution=), 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10:41:00 CST 2016, time=2016-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1934787, encodeId=09f81934e87be, content=<a href='/topic/show?id=1072646328c' target=_blank style='color:#2F92EE;'>#治疗指南#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64632, encryptionId=1072646328c, topicName=治疗指南)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6732482, createdName=w984445tii, createdTime=Thu Nov 26 00:19:00 CST 2015, time=2015-11-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1749117, encodeId=00981e4911767, content=<a href='/topic/show?id=843ee2425a1' target=_blank style='color:#2F92EE;'>#直接PCI#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72425, encryptionId=843ee2425a1, topicName=直接PCI)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cef136235391, createdName=xuyu, createdTime=Tue Oct 04 16:19:00 CST 2016, time=2016-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=75224, encodeId=ac1ae5224a9, content=可以, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/07/08/e29a8e183b56a54a182b51012b36874c.jpg, createdBy=7fa61707564, createdName=Frankenstein, createdTime=Sat Apr 02 11:28:00 CST 2016, time=2016-04-02, status=1, ipAttribution=)]
    2016-04-14 12498c32m68暂无昵称

    #STEMI患者#

    0

  5. 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10:41:00 CST 2016, time=2016-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1934787, encodeId=09f81934e87be, content=<a href='/topic/show?id=1072646328c' target=_blank style='color:#2F92EE;'>#治疗指南#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64632, encryptionId=1072646328c, topicName=治疗指南)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6732482, createdName=w984445tii, createdTime=Thu Nov 26 00:19:00 CST 2015, time=2015-11-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1749117, encodeId=00981e4911767, content=<a href='/topic/show?id=843ee2425a1' target=_blank style='color:#2F92EE;'>#直接PCI#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72425, encryptionId=843ee2425a1, topicName=直接PCI)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cef136235391, createdName=xuyu, createdTime=Tue Oct 04 16:19:00 CST 2016, time=2016-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=75224, encodeId=ac1ae5224a9, content=可以, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/07/08/e29a8e183b56a54a182b51012b36874c.jpg, createdBy=7fa61707564, createdName=Frankenstein, createdTime=Sat Apr 02 11:28:00 CST 2016, time=2016-04-02, status=1, ipAttribution=)]
    2016-08-20 doctorJiangchao

    继续学习

    0

  6. 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10:41:00 CST 2016, time=2016-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1934787, encodeId=09f81934e87be, content=<a href='/topic/show?id=1072646328c' target=_blank style='color:#2F92EE;'>#治疗指南#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64632, encryptionId=1072646328c, topicName=治疗指南)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6732482, createdName=w984445tii, createdTime=Thu Nov 26 00:19:00 CST 2015, time=2015-11-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1749117, encodeId=00981e4911767, content=<a href='/topic/show?id=843ee2425a1' target=_blank style='color:#2F92EE;'>#直接PCI#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72425, encryptionId=843ee2425a1, topicName=直接PCI)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cef136235391, createdName=xuyu, createdTime=Tue Oct 04 16:19:00 CST 2016, time=2016-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=75224, encodeId=ac1ae5224a9, content=可以, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/07/08/e29a8e183b56a54a182b51012b36874c.jpg, createdBy=7fa61707564, createdName=Frankenstein, createdTime=Sat Apr 02 11:28:00 CST 2016, time=2016-04-02, status=1, ipAttribution=)]
    2016-08-20 doctorJiangchao

    继续关注

    0

  7. 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10:41:00 CST 2016, time=2016-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1934787, encodeId=09f81934e87be, content=<a href='/topic/show?id=1072646328c' target=_blank style='color:#2F92EE;'>#治疗指南#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64632, encryptionId=1072646328c, topicName=治疗指南)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6732482, createdName=w984445tii, createdTime=Thu Nov 26 00:19:00 CST 2015, time=2015-11-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1749117, encodeId=00981e4911767, content=<a href='/topic/show?id=843ee2425a1' target=_blank style='color:#2F92EE;'>#直接PCI#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72425, encryptionId=843ee2425a1, topicName=直接PCI)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cef136235391, createdName=xuyu, createdTime=Tue Oct 04 16:19:00 CST 2016, time=2016-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=75224, encodeId=ac1ae5224a9, content=可以, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/07/08/e29a8e183b56a54a182b51012b36874c.jpg, createdBy=7fa61707564, createdName=Frankenstein, createdTime=Sat Apr 02 11:28:00 CST 2016, time=2016-04-02, status=1, ipAttribution=)]
    2016-07-27 午夜星河

    学习了讴歌了

    0

  8. 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10:41:00 CST 2016, time=2016-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1934787, encodeId=09f81934e87be, content=<a href='/topic/show?id=1072646328c' target=_blank style='color:#2F92EE;'>#治疗指南#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64632, encryptionId=1072646328c, topicName=治疗指南)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6732482, createdName=w984445tii, createdTime=Thu Nov 26 00:19:00 CST 2015, time=2015-11-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1749117, encodeId=00981e4911767, content=<a href='/topic/show?id=843ee2425a1' target=_blank style='color:#2F92EE;'>#直接PCI#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72425, encryptionId=843ee2425a1, topicName=直接PCI)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cef136235391, createdName=xuyu, createdTime=Tue Oct 04 16:19:00 CST 2016, time=2016-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=75224, encodeId=ac1ae5224a9, content=可以, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/07/08/e29a8e183b56a54a182b51012b36874c.jpg, createdBy=7fa61707564, createdName=Frankenstein, createdTime=Sat Apr 02 11:28:00 CST 2016, time=2016-04-02, status=1, ipAttribution=)]
    2015-11-26 w984445tii

    #治疗指南#

    0

  9. 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10:41:00 CST 2016, time=2016-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1934787, encodeId=09f81934e87be, content=<a href='/topic/show?id=1072646328c' target=_blank style='color:#2F92EE;'>#治疗指南#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64632, encryptionId=1072646328c, topicName=治疗指南)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6732482, createdName=w984445tii, createdTime=Thu Nov 26 00:19:00 CST 2015, time=2015-11-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1749117, encodeId=00981e4911767, content=<a href='/topic/show?id=843ee2425a1' target=_blank style='color:#2F92EE;'>#直接PCI#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72425, encryptionId=843ee2425a1, topicName=直接PCI)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cef136235391, createdName=xuyu, createdTime=Tue Oct 04 16:19:00 CST 2016, time=2016-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=75224, encodeId=ac1ae5224a9, content=可以, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/07/08/e29a8e183b56a54a182b51012b36874c.jpg, createdBy=7fa61707564, createdName=Frankenstein, createdTime=Sat Apr 02 11:28:00 CST 2016, time=2016-04-02, status=1, ipAttribution=)]
    2016-10-04 xuyu

    #直接PCI#

    0

  10. 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    2016-04-02 Frankenstein

    可以

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