对多支血管的冠心病选择经皮血管成形术或者外科手术的血管成形术.pptVIP免费

PercutaneousorSurgicalPercutaneousorSurgicalRevascularizationforMultivesselRevascularizationforMultivesselCoronaryArteryDisease?CoronaryArteryDisease?VergheseMathew,MD,FACCVergheseMathew,MD,FACCConsultant,DivisionofCardiovascularDiseasesandConsultant,DivisionofCardiovascularDiseasesandDepartmentofRadiologyDepartmentofRadiologyProfessorofMedicine,MayoClinicCollegeofMedicineProfessorofMedicine,MayoClinicCollegeofMedicineRevascularizationStrategiesRevascularizationStrategiesHowdowedecide?AnatomyClinicalPatientpresentationpreferenceRiskvs.BenefitInvasiveTherapiesInvasiveTherapiesLowRiskPatientLowRiskPatientHighRiskPatientHighRiskPatientSomeacuteSomeacuteriskriskLesslong-termriskLesslong-termriskreductionreductionGreateracuteGreateracuteriskriskGreaterlong-termGreaterlong-termriskreductionriskreduction12-YearSurvivalinPatientswithCAD12-YearSurvivalinPatientswithCAD7354210255075100>5035-49<35EmondMetal:Circ90:2645,199423,467Medically-TreatedPatientsinCASSRegistry23,467Medically-TreatedPatientsinCASSRegistryLVEFCP1203018-212-YearSurvivalinPatientswithCAD12-YearSurvivalinPatientswithCAD887450400255075100NoCAD1vessel2vessel3vesselEmondMetal:Circ90:2645,199423,467Medically-TreatedPatientsinCASSRegistry23,467Medically-TreatedPatientsinCASSRegistryCP1203018-1ClinicalPresentationClinicalPresentation•AgeAge•AcuteischemicsyndromeversuschronicAcuteischemicsyndromeversuschronicstableanginastableangina•Priorcardiachistory(MI,CABG,Priorcardiachistory(MI,CABG,intervention)intervention)•Co-morbidconditions(diabetes,Co-morbidconditions(diabetes,cerebrovasculardisease,renaldisease,cerebrovasculardisease,renaldisease,lungdisease)lungdisease)•FunctionalimpairmentFunctionalimpairment•IschemicburdenIschemicburdenExtensionofSurvivalwithCABGvsMedicalExtensionofSurvivalwithCABGvsMedicalTherapyAfter10YearsTherapyAfter10Years-4-202468101214161820CP1203018-14Extensionofsurvival(mo)Extensionofsurvival(mo)YusufSetal:Lancet344:563,1994YusufSetal:Lancet344:563,1994OverallOverallVesseldisease1/...