Медикаменты,ангиопластика,хирургия:как найти баланс

Проблемы
Стабильная стенокардия
ОКС без элевации ST
ОКС с элевацией ST

Первичная ангиопластика в сравнении с тромболизисом

Mortality rates with primary PCI as a function of PCI-related time delay
Circle sizes = sample size of the individual study.
Solid line = weighted meta-regression.
62 min
Benefit
Favors PCI
Harm
Favors Lysis
For Every 10 min delay to PCI: 1% reduction in mortality difference towards lytics

Door to Balloon Times Among Patients
Transferred in NRMI 4
Door to
Data:
50th: 9 Min.
25th: 4 Min.
75th: 16 Min.
Data to
Cath Lab Arrival:
50th: 132 Min.
25th: 88 Min.
75th: 219 Min.
Cath Lab to
Balloon:
50th: 37 Min.
25th: 28 Min
75th: 50 Min.
9
132
37
Total Door 1 to Balloon Time: 185 minutes (25th: 137; 75th: 276)
Percent of Patients with Door to Balloon Time < 90 Min.: 3.0%
Sample Size: 1,346; Time Period: January 2002 – December 2002
Accessed on August 6, 2004 http://www.acc.org/clinical/ guidelines/stemi/index.pdf. pg.61

CAPTIM
Comparison of Angioplasty and Prehospital Thrombolysis in Acute Myocardial Infarction
Primary Composite Endpoint- Death, Reinfarction, Disabling Stroke
Bonnefoy E, et al. Lancet 2002;360:825-9

CAPTIM -1Year Results
Sx to Treatment Analysis
Touboul P. Presented at: The 18th International Symposium on Thrombolysis and Interventional Therapy in Acute Myocardial Infarction - George Washington University Symposium; November 16, 2002; Chicago, Ill.
Sx < 2 h
0.0
Death
Sx ≥ 2 h
5.0
7.5
2.5
Pre-hospital Lysis
Primary PCI
2.2
5.7
Death
P=0.057
0.0
7.5
10.0
2.5
Pre-hospital Lysis
Primary PCI
5.9
3.7
Death
P=0.47
5.0
Percent

Материалы МУЗ МКБ СМП № 2 за 2005 г

Зависимость летальности от возраста
125
29
353
24
6.8%
23.2%

Эффективность тромболизиса в зависимости от возраста

Увеличение летальности у больных РЕ-ИМ

Кривые Каплана-Мейера выживаемости больных Ре-ИМ