ACEI在STEMI指南地位課件

1、ACEI在2013版ACC/AHA STEMI指南中的地位ACEI在STEMI指南地位主要內容 2013版ACC/AHA STEMI指南主要變化 ACEI在ACC/AHA STEMI指南中的基石地位 FAMIS：第三代ACEI蒙諾在急性心梗中的研究ACEI在STEMI指南地位2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial InfarctionDeveloped in Collaboration with American College of Emergency Physicians and Socie

2、ty for Cardiovascular Angiography and Interventions American College of Cardiology Foundation and American Heart Association, Inc.2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction (Journal of the American College of Cardiology). Published on December 17, 2012ACEI在STEMI

3、指南地位Reperfusion Therapy for Patients with STEMI*Patients with cardiogenic shock or severe heart failure initially seen at a nonPCI-capable hospital should be transferred for cardiac catheterization and revascularization as soon as possible, irrespective of time delay from MI onset (Class I, LOE: B).

4、 Angiography and revascularization should not be performed within the first 2 to 3 hours after administration of fibrinolytic therapy.ACEI在STEMI指南地位Regional Systems of STEMI Care, Reperfusion Therapy, and Time-to-Treatment Goals All communities should create and maintain a regional system of STEMI c

5、are that includes assessment and continuous quality improvement of EMS and hospital-based activities. Performance can be facilitated by participating in programs such as Mission: Lifeline and the D2B Alliance. I IIa IIb IIIPerformance of a 12-lead ECG by EMS personnel at the site of FMC is recommend

6、ed in patients with symptoms consistent with STEMI. I IIa IIb IIIACEI在STEMI指南地位ACEI在STEMI指南地位Primary PCI in STEMIACEI在STEMI指南地位ACEI在STEMI指南地位Adjunctive Antithrombotic Therapy to Support Reperfusion With Primary PCI*The recommended maintenance dose of aspirin to be used with ticagrelor is 81 mg daily

7、.ACEI在STEMI指南地位ACEI在STEMI指南地位ACEI在STEMI指南地位ACEI在STEMI指南地位ACEI在STEMI指南地位ACEI在STEMI指南地位ACEI在STEMI指南地位ACEI在STEMI指南地位ACEI在STEMI指南地位ACEI在STEMI指南地位ACEI在STEMI指南地位ACEI在STEMI指南地位ACEI在STEMI指南地位ACEI在STEMI指南地位ACEI在STEMI指南地位ACEI在STEMI指南地位ACEI在STEMI指南地位ACEI在STEMI指南地位ACEI在STEMI指南地位ACEI在STEMI指南地位ACEI在STEMI指南地位ACEI在

8、STEMI指南地位ACEI在STEMI指南地位ACEI在STEMI指南地位Renin-Angiotensin-Aldosterone Renin-Angiotensin-Aldosterone System InhibitorsSystem InhibitorsRoutine Medical TherapiesACEI在STEMI指南地位Renin-Angiotensin-Aldosterone System InhibitorsAn ACE inhibitor should be administered within the first 24 hours to all patients w

9、ith STEMI with anterior location, HF, or EF less than or equal to 0.40, unless contraindicated. An ARB should be given to patients with STEMI who have indications for but are intolerant of ACE inhibitors. I IIa IIb IIII IIa IIb IIIACEI在STEMI指南地位Renin-Angiotensin-Aldosterone System InhibitorsAn aldos

10、terone antagonist should be given to patients with STEMI and no contraindications who are already receiving an ACE inhibitor and beta blocker and who have an EF less than or equal to 0.40 and either symptomatic HF or diabetes mellitus. ACE inhibitors are reasonable for all patients with STEMI and no

11、 contraindications to their use. I IIa IIb IIII IIa IIb IIIACEI在STEMI指南地位Renin-Angiotensin-Aldosterone SystemBIRKENHGERLANCET 2007Vasoconstriction, Oxidative Stress, Cellular GrowthACEI在STEMI指南地位ACEI與ARB對心血管的保護作用不同腎素腎素RPR受體受體AT2受體受體血管舒張血管舒張抗增殖抗增殖凋亡凋亡血管緊張素原血管緊張素原Ang IAng IIAT1受體受體血管收縮血管收縮細胞增殖細胞增殖基質形成

12、基質形成醛固酮分泌醛固酮分泌血管舒張血管舒張一氧化氮一氧化氮前列腺素前列腺素EDHF無活性肽無活性肽激肽原激肽原緩激肽緩激肽激肽釋放酶激肽釋放酶BK B2受體受體ACE ACEIACEIACEIACEI增加增加炎癥因子炎癥因子 PAI-1IRAP受體受體Ang AMP-A/MNEPAng(1-5)無活性肽無活性肽 Ang-(1-7)ACEAng(1-9) AT2受體受體 ACE2ACE2NEP& ACE血管舒張血管舒張抗增殖抗增殖Mas受體受體ARB廖玉華. 臨床心血管病雜志, 2012, 28(8):561-562ACEI在STEMI指南地位 FAMISPost Acute Myoc

13、ardial InfarctionThe Fosinopril in Acute Myocardial Infarction Study(急性心肌梗死后，福辛普利的應用研究)Claudio Borghi, et al., Am J Hypertens 1997; 10: 247S-254SACEI在STEMI指南地位研究目的研究目的：研究在出現(xiàn)癥狀6小時內溶栓的急性前壁心肌梗塞患者早期（ 100 mm Hg，則逐漸加倍至目標劑量每天20mg，或安慰劑，服用3個月ACEI在STEMI指南地位結果1：福辛普利對左室收縮功能障礙 (射血分數(shù)0.05+與安慰劑組相比， P0.05ACEI在STEMI指南地位FAMIS研究結論及意義早期福辛普利和溶栓聯(lián)合治療能顯著減緩急性心?；颊逤HF的病