选择性醛固酮封锁需与瞬态或永久心脏的急性心肌梗死住院期间衰竭患者_第1页
选择性醛固酮封锁需与瞬态或永久心脏的急性心肌梗死住院期间衰竭患者_第2页
选择性醛固酮封锁需与瞬态或永久心脏的急性心肌梗死住院期间衰竭患者_第3页
选择性醛固酮封锁需与瞬态或永久心脏的急性心肌梗死住院期间衰竭患者_第4页
选择性醛固酮封锁需与瞬态或永久心脏的急性心肌梗死住院期间衰竭患者_第5页
已阅读5页,还剩36页未读 继续免费阅读

下载本文档

版权说明:本文档由用户提供并上传,收益归属内容提供方,若内容存在侵权,请进行举报或认领

文档简介

1、会计学1选择性醛固酮封锁需与瞬态或永久心脏选择性醛固酮封锁需与瞬态或永久心脏的急性心肌梗死住院期间衰竭患者的急性心肌梗死住院期间衰竭患者EVENTAMI + CHF (%)AMI (%)Stroke 2.21.4A V block5.74.6VT or VF11.99.09Rupture/EMD1.81.0Unexpected cardiac arrest8.34.4LOS7.15.3Recurrent MI3.02.7Death21.47.2Cardiac Echo performed within 24 hrs after AMIACS = acute coronary syndromes

2、.Steg PG et al. Circulation. 2004;109:494-499.Time to Death Within 6 Months (n = 10,771)0.30.20.10.0012346HR = 3.8 (95% CI, 3.33 to 4.36)Heart failure at admissionNo heart failure at admissionProportion Dead5ACE-I = angiotensin-converting enzyme inhibitor; Ang I = angiotensin I; ARB = angiotensin II

3、 blocker.Alternative PathwaysAldosterone: Important Component of Renin-Angiotensin-Aldosterone SystemAdapted from Weber KT, Brilla CG. Circulation 1991;83:1849-1865.PlasmaHBP LVHFibrosisAngiotensin II Aldosterone Angiotensin IIAldosteroneAngiotensin IIAldosteroneYesYesYesYesYesYesYesYesNoHBP = high

4、blood pressure; LVH = left ventricular hypertrophy AldosteroneCardiac fibroblasts Collagen synthesis Collagen depositionMyocardial Fibrosis LV stiffnessLVDCHFAldosterone Receptor AntagonistsAdapted from Hameedi and Chadow. Curr Hypertens Rep. 2000;2:378-383VSMC = vascular smooth muscle cell; NO = ni

5、tric oxide; ET-1 = endothelin-1.Rajagopalan and Pitt. Med Clin North Am. 2003;87:441-457.McKelvie et al. Circulation 1999;100:1056-64 5040302010 0-20-10-30-40D D Aldosterone (pg/mL)17 weeks43 weeksCandesartan 4 mgCandesartan 8 mgCandesartan 16 mgCandesartan+ Enalapril 4 mg/20mgCandesartan+ Enalapril

6、 8 mg/20mgEnalapril 20 mgAldosterone Rebound Occurs Even with Combined ACE-I and AII Blocker (RESOLVD)11The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators. Lancet. 1993;342:821-828. PlaceboRamiprilTime (months)353025201510500612182430HR 0.73 (95% CI, 0.60 to 0.89)P = .002Cumulative Mo

7、rtality (%)RR: 27%LV = left ventricular; HR = hazard ratio; RR = risk reduction.12HR = hazard ratio; RR = risk reduction.The CAPRICORN Investigators. Lancet. 2001;357:1385-1390.PlaceboCarvedilolProportion Event-FreeYears1.00.90.80.70.60.50.40.30.20.10.000.51.01.52.02.5HR 0.77 (95% CI, 0.60 to 0.98)P

8、 = .031RR:23%13Adapted from Pfeffer MA et al. N Engl J Med. 2003;349:1893-1906. Probability of Event0.40.30.20.10.0061218243036MonthsProbability of Event12Months0.40.30.20.10.00618243036CaptoprilValsartanValsartan and CaptoprilDeath From Any CauseCombined Cardiovascular Endpoint14Primary endpoints:S

9、econdary endpoints:Total mortalityCV mortality/CV hospitalizationsCV mortalityTotal mortality/total hospitalizationsEplerenone 25 to 50 mg qd(n = 3319)Placebo (n = 3313)6632 Patients 3 to 14 DaysPost-MI1012 DeathsPitt B et al. N Engl J Med. 2003;348:1309-1321.Acute MI, Heart Failure, LVEF 40%, Stand

10、ard TherapyRR:31%Pitt B et al. Abstract presented at: ESC Working Group on Acute Cardiac Care; 2004.EPHESUS Co-Primary Endpoint:Total Mortality (30 Days)Eplerenone + standard care Placebo + standard care Cumulative Incidence (%)Days From RandomizationHR = 0.69 (95% CI, 0.54 to 0.89)(4.6%)(3.2%)P = .

11、004HR = hazard ratio.RR = risk reduction.Adapted from Pitt B et al. N Engl J Med. 2003;348:1309-1321.Eplerenone + standard care (n = 3319)Placebo + standard care (n = 3313)Cumulative Incidence (%)2220181614121086420369121518212427Months Since RandomizationHR = 0.85 (95% CI, 0.75 to 0.96)P = .0080RR:

12、15%(16.7%)(14.4%)HR = hazard ratio.RR = risk reduction.HR = 0.87 (95% CI, 0.74 to 1.01)Pitt B et al. Abstract presented at: ESC Working Group on Acute Cardiac Care; 2004.RR:13%Eplerenone + standard carePlacebo + standard careCumulative Incidence (%)Days From Randomization(9.9%)(8.6%)HR = hazard rati

13、o.RR = risk reduction.P = .074Adapted from Pitt B et al. N Engl J Med. 2003;348:1309-1321.Eplerenone + standard care (n = 3319)Placebo + standard care (n = 3313)40Cumulative Incidence (%)35302520151050369121518212427HR = 0.87 (95% CI, 0.79 to 0.95)P = .0020Months Since RandomizationRR:13%(30.0%)(26.

14、7%)HR = hazard ratio.RR = risk reduction.Adapted from Pitt B et al. N Engl J Med. 2003;348:1309-1321.Eplerenone + standard care (n = 3319)Placebo + standard care (n = 3313)10Cumulative Incidence (%)86543210369121518212427HR = 0.79 (95% CI, 0.64 to 0.97)P = 0.03097Months Since RandomizationRR:21%HR =

15、 hazard ratio.RR = risk reduction.Eplerenonen (%)Placebon (%)P valueInvestigator reportedHyperkalemia113 (3.4%)66 (2.0%).001Hypokalemia15 (0.5%)49 (1.5%).001Laboratory assessed6.0 mEq/L180 (5.5%)126 (3.9%).0023.5 mEq/L273 (8.4%)424 (13.1%).001Pitt B et al. N Engl J Med. 2003;348:1309-1321.In-hospita

16、l TherapyDischarge TherapyLV = left ventricular; UFH = unfractionated heparin; LMWH = low-molecular-weight heparin; GP = glycoprotein; PCI = percutaneous coronary intervention.22Pitt B et al. N Engl J Med. 2003;348:1309-1321.2324EplerenonePlaceboMalesGynecomastia0.4%0.5% Mastodynia0.1%0.1%Females Ab

17、normal vaginal bleeding0.4%0.4%2526Serum Potassium (mEq/L)ActionDose Adjustment5.0Increase25 mg qod to 25 mg qd25 mg qd to 50 mg qd5.0-5.4MaintainNo adjustment5.5-5.9Decrease50 mg qd to 25 mg qd25 mg qd to 25 mg qod 25 mg qod to withhold6.0Withhold*Eplerenone can be restarted at 25 mg qod when the p

18、otassium level falls to 5.5 mmol/L)15.6%11.2%.001Incidence K (K+ 6.0 mmol/L)5.5%3.9%.002Study drug discontinuation due to K1%1%Deaths adjudicated to Kn = 0n = 1All deaths due to K + all sudden cardiac death + all deaths from unknown causes5.3%6.6%.016ACE-I = angiotensin-converting enzyme inhibitor;

19、Ang I = angiotensin I; ARB = angiotensin II blocker.Alternative PathwaysAldosterone: Important Component of Renin-Angiotensin-Aldosterone SystemMcKelvie et al. Circulation 1999;100:1056-64 5040302010 0-20-10-30-40D D Aldosterone (pg/mL)17 weeks43 weeksCandesartan 4 mgCandesartan 8 mgCandesartan 16 mgCandesartan+ Enalapril 4 mg/20mgCandesartan+ Enalapril 8 mg/20mgEnalapril 20 mgAldosterone Rebound Occurs Even with Combined ACE-I and AII Blocker (RESOLVD)In-hospital TherapyDischarge TherapyLV = left ve

温馨提示

  • 1. 本站所有资源如无特殊说明,都需要本地电脑安装OFFICE2007和PDF阅读器。图纸软件为CAD,CAXA,PROE,UG,SolidWorks等.压缩文件请下载最新的WinRAR软件解压。
  • 2. 本站的文档不包含任何第三方提供的附件图纸等,如果需要附件,请联系上传者。文件的所有权益归上传用户所有。
  • 3. 本站RAR压缩包中若带图纸,网页内容里面会有图纸预览,若没有图纸预览就没有图纸。
  • 4. 未经权益所有人同意不得将文件中的内容挪作商业或盈利用途。
  • 5. 人人文库网仅提供信息存储空间,仅对用户上传内容的表现方式做保护处理,对用户上传分享的文档内容本身不做任何修改或编辑,并不能对任何下载内容负责。
  • 6. 下载文件中如有侵权或不适当内容,请与我们联系,我们立即纠正。
  • 7. 本站不保证下载资源的准确性、安全性和完整性, 同时也不承担用户因使用这些下载资源对自己和他人造成任何形式的伤害或损失。

评论

0/150

提交评论