文档介绍：Combination Lytic Therapy in Acute Myocardial bination Combination Lytic Lytic Therapy in Therapy in Acute Myocardial Infarction Acute Myocardial Infarction C. Michael Gibson, . C. Michael Gibson, . C. Michael Gibson, . Pathophysiology bination Therapy in AMI Pathophysiology bination Therapy in AMI Pathophysiology bination Therapy in AMI * * Gibson et al. Gibson et al. J Am Coll Cardiol. J Am Coll Cardiol. 1995;25:582-589. 1995;25:582-589. Gibson et al. Gibson et al. Circulation. Circulation. 2001;103:2550-2554. 2001;103:2550-2554. Combination bination Therapy ?? Thrombus Thrombus ??% Stenosis % Stenosis ?? Minimum Diameter Minimum Diameter ?? Epicardial Flow Epicardial Flow ?? Myocardial Blush Myocardial Blush ?? ST Resolution ST Resolution ?? Myocardial Flow Myocardial Flow Facilitates PCI Facilitates PCI Reduces Reduces Reinfarction Reinfarction * * Recent Clinical Trials Recent Clinical Trials Recent Clinical Trials Unfractionated heparin Enoxaparin Unfractionated heparin Enoxaparin Abciximab Abciximab None None ENTIRE ACC/AHA heparin dose Low-dose heparin Enoxaparin None Abciximab None ASSENT-3 Standard-dose heparin Low-dose heparin None Abciximab 50% TNK-tPA 50% TNK-tPA 100% TNK-tPA 100% TNK-tPA 100% TNK-tPA 50% TNK-tPA 100% TNK-tPA 100% r-PA 50% r-PA GUSTO-V Anticoagulant GP IIb/IIIa Receptor Inhibitor Lytic Trial Clinical Trials: Ongoing Clinical Trials: Ongoing Clinical Trials: Ongoing Low-dose heparin Low-dose heparin Low-dose heparin Eptifibatide Eptifibatide Eptifibatide 50% TNK-tPA 75% TNK-tPA 100% TNK-tPA INTEGRITI Low-dose heparin Low-dose heparin Low-dose heparin Tirofiban Tirofiban Tirofiban 50% TNK-tPA 75% TNK-tPA 100% TNK-tPA FASTER Anticoagulant GP IIb/IIIa Receptor Inhibitor Lytic Trial 54% 54% 32% 32% GUSTO-I: A 20% Increase in TIMI Grade 3 Flow is Needed to Yield a 1% Mortality Reduction GUSTO-I: A 20% Increase in TIMI Grade 3 Flow is GUSTO-I: A 20% Increase in TIMI Grade 3 Flow is Needed to Yield a 1% Mortality