ACEI在STEMI指南地位课件

1、ACEI在2013版ACC/AHA STEMI指南中的地位ACEI在STEMI指南地位主要内容 2013版ACC/AHA STEMI指南主要变化 ACEI在ACC/AHA STEMI指南中的基石地位 FAMIS：第三代ACEI蒙诺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与ARB对心血管的保护作用不同肾素肾素RPR受体受体AT2受体受体血管舒张血管舒张抗增殖抗增殖凋亡凋亡血管紧张素原血管紧张素原Ang IAng IIAT1受体受体血管收缩血管收缩细胞增殖细胞增殖基质形成

12、基质形成醛固酮分泌醛固酮分泌血管舒张血管舒张一氧化氮一氧化氮前列腺素前列腺素EDHF无活性肽无活性肽激肽原激肽原缓激肽缓激肽激肽释放酶激肽释放酶BK B2受体受体ACE ACEIACEIACEIACEI增加增加炎症因子炎症因子 PAI-1IRAP受体受体Ang AMP-A/MNEPAng(1-5)无活性肽无活性肽 Ang-(1-7)ACEAng(1-9) AT2受体受体 ACE2ACE2NEP& ACE血管舒张血管舒张抗增殖抗增殖Mas受体受体ARB廖玉华. 临床心血管病杂志, 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，福辛普利的应用研究)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：研究在出现症状6小时内溶栓的急性前壁心肌梗塞患者早期（ 100 mm Hg，则逐渐加倍至目标剂量每天20mg，或安慰剂，服用3个月ACEI在STEMI指南地位结果1：福辛普利对左室收缩功能障碍 (射血分数0.05+与安慰剂组相比， P0.05ACEI在STEMI指南地位FAMIS研究结论及意义早期福辛普利和溶栓联合治疗能显著减缓急性心梗患者CHF的病