冠心病治療策略的演變冠心病治療策略的演變冠心病治療策略的演變冠心病治療觀念的改變NovelChangesinConceptofElderlyCHDTreatmentLuminalstenosistovulnerableplaqueformation從重視管腔狹窄到易損斑塊Lipiddeposittoinflammatoryresponse從注意脂質沉積到炎癥反應Vulnerableplaquetovulnerablepatient從重視易損斑塊到易損病人SingleRFcontroltomulti-RFintervention從單一危險因素控制到多個危險因素聯(lián)合干預Standardizedtreatmenttoindividualizedtherapy從注重規(guī)范化治療到個體化治療冠心病治療觀念改變之FirstChangeinConceptofchdtreatmentLuminalstenosisVulnerablePlaque管腔狹窄易損斑塊冠心病治療策略的演變冠心病治療策略的演變冠心病治療策略的演變1冠心病治療觀念的改變NovelChangesinConceptofElderlyCHDTreatmentLuminalstenosistovulnerableplaqueformation從重視管腔狹窄到易損斑塊Lipiddeposittoinflammatoryresponse從注意脂質沉積到炎癥反應Vulnerableplaquetovulnerablepatient從重視易損斑塊到易損病人SingleRFcontroltomulti-RFintervention從單一危險因素控制到多個危險因素聯(lián)合干預Standardizedtreatmenttoindividualizedtherapy從注重規(guī)范化治療到個體化治療冠心病治療觀念的改變2冠心病治療觀念改變之FirstChangeinConceptofchdtreatmentLuminalstenosisVulnerablePlaque管腔狹窄易損斑塊冠心病治療觀念改變之3動脈粥樣硬化的傳統(tǒng)觀念TraditionalConceptofatherosclerosisDegreeofCoronaryStenosisRiskofchd冠脈狹窄程度冠心病嚴重度動脈粥樣硬化的傳統(tǒng)觀念4急性心梗前的冠脈狹窄程度CoronaryArteryStenosispre-AMI850-70%0>70%ofDiameterStenosis(n=195Falkerelcreston.D9592:657急性心梗前的冠脈狹窄程度5降脂療法降低心臟事件但并不改變管腔狹窄Lipid-loweringTherapiesDecreaseCardiacEventsbutNotStenosisTrialCholesterolDecreaseCardiaceventdecrease%oChangeinStenosis.%oFATSSTARS0.5±3.6STARS1.5±4.0SCRIP0.3±2.5PLAC10.69LevineGN,KeaneyJFJrVitaJA.CholesterolreductionincardiovasculardiseaEng/JMed,199532:512-5212.PhilbinEFPearsonTA.Howdoeslipid-loweringtherapyrapidlyreduceischemicevents?MyocardIschemia,1994;6:13-18.PittB,ManciniGB,EllisSG,RosmanHS,ParkJ-5,McGovernMEforthePLACIinvestigatorsPravastatin/imitationoftherasckerosisinthecoronaryarteries(PLACI):reductioninatherosclerosisprogressionandclinicalevents.JAmCollardo.199526:113-1139降脂療法降低心臟事件但并不改變管腔狹窄6CoronaryArteryStenosisAndCardiacEvents冠脈狹窄與心臟事件Plaquevolumeorseverityofcoronaryarterystenosismaynotbethekeyfactorforinducingcardiacevents.提示:冠脈狹窄并非心血管事件關鍵原因CoronaryArteryStenosisAndC7ConceptofVulnerablePlaque易損斑塊概念的提出In1989,Mullerandcolleaguesfirstused"vulnerableplaques"todescriberupture-proneplaquesastheunderlyingcauseofmostclinicalcoronaryevents.首侶易損斑塊破裂觀念Avulnerableplaqueoftenhasalargelipidpool,athincap,andmacrophage-denseinflammationonorbeneathitssurface+TEVulnerableplaqueruptureordisruptioncausesbleedingintotheplaque,luminalthrombosis,andorvasospasmthatmaycausesuddenflowobstructionandischemicinjury.破裂致血栓形成MullerJ,ToflerG,StoneP.Circadianvariationandtriggersofonsetofacutecardiovasculardisease.Circulation.1989:79:733-743ConceptofVulnerablePlaque8冠心病治療策略的演變課件9多方位策略演變Manysidedstrategicchanges■診斷進步:由以CAG為主導,到重視斑塊檢測技術的發(fā)展如rUs、oCTn基礎研究方向:逐漸以穩(wěn)定易損斑塊以及減少斑塊破裂后血栓形成為方n二級預防重點:也將由治療冠脈狹窄轉為易損斑塊的干預。RupturedPlaque多方位策略演變10冠心病治療策略的演變課件11冠心病治療策略的演變課件12冠心病治療策略的演變課件13冠心病治療策略的演變課件14冠心病治療策略的演變課件15冠心病治療策略的演變課件16冠心病治療策略的演變課件17冠心病治療策略的演變課件18冠心病治療策略的演變課件19冠心病治療策略的演變課件20冠心病治療策略的演變課件21冠心病治療策略的演變課件22冠心病治療策略的演變課件23冠心病治療策略的演變課件24冠心病治療策略的演變課件25冠心病治療策略的演變課件26冠心病治療策略的演變課件27冠心病治療策略的演變課件28冠心病治療策略的演變課件29冠心病治療策略的演變課件30冠心病治療策略的演變課件31冠心病治療策略的演變課件32冠心病治療策略的演變課件33冠心病治療策略的演變課件34冠心病治療策略的演變課件35冠心病治療策略的演變課件36冠心病治療策略的演變課件37冠心病治療策略的演變課件38冠心病治療策略的