文档介绍：汇报人： 时间：2020
本模板有完整的思路及框架，更贴近实用
急性心肌梗塞的溶栓治疗
Pathophysiology of Combination Therapy in AMI
*Gibson et al. J Am Collprovement would be predicted to improve mortality by %
The SPEED Study Group. Circulation. 2000;101:2788-2794.
0
40
80
100
r-PA 10+10 U
r-PA 5+5 U + Abx
60
20
Patency (%)
TIMI-2
TIMI-3
n=109
n=115
GUSTO-V: Study Design
The GUSTO-V Investigators. Lancet. 2019;357:1905-1914.
ST , lytic eligible, < 6 h (n=16,588)
ASA
No Abciximab
2 x 10 U bolus (30’)
Full-dose r-PA
Abciximab
Low-dose Heparin:
60 U/kg bolus followed by 7 U/kg/h infusion
1º end point: mortality at 30 days
2º end point: clinical and safety events at 30 days
2 x 5 U bolus (30’)
Half-dose r-PA
Standard Heparin:
5000 U bolus followed by 800 U/h (< 80 kg) or 1000 U/h ( 80 kg) infusion
Primary End Point: 30-Day Mortality
The GUSTO-V Investigators. Lancet. 2019;357:1905-1914.
0
% Mortality
Days
0
5
10
15
20
25
30
P=.43 for superiority
Non-Inferiority RR
(95% CI, -)
Std. Reteplase (n = 8260)
Abx + Dose Reteplase (n = 8328)
4
6
2
%
%
*
*
*
*
GUSTO-V: PCI Within 6 Hours (Urgent) and Through Day 7
*P<.0001.
The GUSTO-V Investigators. Lancet. 2019;357:1905-1914.
0
15
25
30
20
10
PCI (%)
Urgent
Through Day 7
5
r-PA
r-PA + Abx
GUSTO-V: Event Rates in Those Requiring Urgent PCI
Heartwire News. September 2, 2019. GUSTO-V: Combination half-dose fibrinolytic plus IIb/IIIa blocker. An Alternative approach to MI?
0
4
10
12
8
Myocardial Infarction (%)
r-PA
r-PA + Abx
n=1173
Death
Repeat MI
Death Plus Repeat MI
2
6
GUSTO-V: Conclusions
Compared with r-PA monotherapy, combination therapy with r-PA and abciximab resulted in
A mortality rate that was not inferior to r-PA monotherapy
Fewer nonfatal reinfarctions (primarily a reduced incidence of recurrent ST elevation)
A lower rate of urgent revascularization
More noncerebra