1、受體阻滯劑在PCI術(shù)的應(yīng)用,CV-1211-BE-0451 有效期至2013年12月,1,心率增快增加冠心病患者的風(fēng)險(xiǎn)！,2,The effect of heart rate on local haemodynamic forces on the endothelium.,Mechanisms whereby an elevated heart rate leads to adverse outcomes in patients with coronary artery disease.,3,4,阻滯劑在急性心肌梗死的應(yīng)用,5,阻滯劑在慢性穩(wěn)定性心絞痛的應(yīng)用,Expert consensus

2、document on -adrenergic receptor blockers. European Heart Journal .2004, 25: 13411362.,6,阻滯劑在非ST段抬高ACS的應(yīng)用,7,實(shí)踐與指南的差距：阻滯劑在中國(guó)冠心病患者中使用現(xiàn)狀,中華醫(yī)學(xué)會(huì)心血管病學(xué)分會(huì)中華心血管病雜志編輯委員會(huì).腎上腺素能受體阻滯劑在心血管疾病應(yīng)用專家共識(shí).,使用率低,使用時(shí)間滯后,劑量較低,獲益漸少,8,受體阻滯劑在PCI圍手術(shù)期的應(yīng)用,9,但是在PCI圍手術(shù)期間的使用？,2009 Focused Updates: ACC/AHA Guidelines for the Manageme

3、nt of Patients With ST-Elevation Myocardial Infarction. 2007 Focused Update of the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention. .,Antithrombotic： 1. UH, LMWH 2. GP IIb/IIIa Inhibitors 3. Bivalirudin,-block？ statin ？,Antiplatelet： 1. Aspirin 2. clopidogrel,10,受體阻斷劑在PCI圍手

4、術(shù)期間的使用,術(shù)前 術(shù)中 術(shù)后,11,PCI術(shù)前使用阻滯劑漸少術(shù)后CK-MB的上升,Samin K. Sharma, Annapoorna Kini, Jonathan D. Marmur,et al. Cardioprotective Effect of Prior -Blocker Therapy in Reducing Creatine Kinase-MB Elevation After Coronary Intervention . Circulation. 2000,102:166 -172,PCI術(shù)前使用阻滯劑與未使用組術(shù)后CK-MB增高的發(fā)生率及增高程度比較,12,術(shù)前使用阻滯劑

5、對(duì)AMI PCI術(shù)后臨床預(yù)后的影響,Harjai KJ, Stone GW, Boura J, et al. Effects of prior beta-blocker therapy on clinical outcomes after primary coronary angioplasty for acute myocardial infarction. Am J Cardiol 2003;91:65560.,AMI PCI術(shù)前使用BB與未使用兩組術(shù)后并發(fā)癥、住院期間及一年隨訪臨床預(yù)后的比較,13,AMI PCI術(shù)前靜注阻滯劑提高術(shù)后生存率,Amir Halkin , Cindy L.

6、Grines , David A. Cox ,et.al.Impact of intravenous Beta-Blockade before primary angioplasty on survival in patients undergoing mechanical reperfusion therapy for acute myocardial infarction. J Am Coll Cardiol, 2004; 43:1780-1787 .,術(shù)前靜脈注射BB與未注射組隨訪三個(gè)月及一年生存率的比較,14,急性心肌梗塞PCI術(shù)后使用阻滯劑對(duì)臨床預(yù)后的影響,AMI PCI術(shù)后使用阻滯

7、劑顯著漸少六個(gè)月死亡風(fēng)險(xiǎn),15,PCI術(shù)后使用阻滯劑漸少一年死亡率,PCI術(shù)后使用BB與未使用組隨訪一年生存率的比較.P=0.0014.,Albert W. Chan, Martin J. Quinn, Deepak L. Bhatt, et.al, Mortality Benefit of Beta-Blockade After Successful Elective Percutaneous Coronary Intervention. Journal of the American College of Cardiology.2002,40(4)670-675.,16,Am Heart

8、J 2003;145:875-81,17,Conclusions -Adrenergic receptor blockers prescribed after PCI reduced the risk of clinical restenosis, target lesion restenosis, and MACE in this cohort of 4840 patients. The mechanism by which -blockers conferred a protective effect against restenosis remains to be determined.

9、 (Am Heart J 2003;145:875-81.),PCI術(shù)后長(zhǎng)期使用受體阻斷劑可以明顯減少再狹窄及臨床事件！,18,圍PCI期間使用受體阻斷劑基于以下幾個(gè)方面,抗炎與穩(wěn)定斑塊 心肌保護(hù) 預(yù)防再狹窄！,19,These findings suggest that metoprolol could inhibit the development of atherosclerosis and stabilize vulnerable plaque by regulation of lipid and reduction of inflammation, in which the chan

10、ge from low shear stress to physiological shear stress around plaque may play an important role.,20,21,Conclusions: The intravenous administration of metoprolol before coronary reperfusion results in larger myocardial salvage than its oral administration initiated early after reperfusion. If confirmed in the clinical setting, the timing and route of -blocker initiation could be revi