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Медикаменты,ангиопластика, хирургия:как найти баланс

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Медикаменты,ангиопластика, хирургия:как найти баланс Беленький Дмитрий Ильич


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Проблемы Стабильная стенокардия ОКС без элевации ST ОКС с элевацией ST


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Первичная ангиопластика в сравнении с тромболизисом


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Mortality rates with primary PCI as a function of PCI-related time delay Circle sizes = sample size of the individual study. Solid line = weighted meta-regression. 62 min Benefit Favors PCI Harm Favors Lysis For Every 10 min delay to PCI: 1% reduction in mortality difference towards lytics


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Door to Balloon Times Among Patients Transferred in NRMI 4 Door to Data: 50th: 9 Min. 25th: 4 Min. 75th: 16 Min. Data to Cath Lab Arrival: 50th: 132 Min. 25th: 88 Min. 75th: 219 Min. Cath Lab to Balloon: 50th: 37 Min. 25th: 28 Min 75th: 50 Min. 9 132 37 Total Door 1 to Balloon Time: 185 minutes (25th: 137; 75th: 276) Percent of Patients with Door to Balloon Time < 90 Min.: 3.0% Sample Size: 1,346; Time Period: January 2002 – December 2002 Accessed on August 6, 2004 http://www.acc.org/clinical/ guidelines/stemi/index.pdf. pg.61


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CAPTIM Comparison of Angioplasty and Prehospital Thrombolysis in Acute Myocardial Infarction Primary Composite Endpoint- Death, Reinfarction, Disabling Stroke Bonnefoy E, et al. Lancet 2002;360:825-9


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CAPTIM -1Year Results Sx to Treatment Analysis Touboul P. Presented at: The 18th International Symposium on Thrombolysis and Interventional Therapy in Acute Myocardial Infarction - George Washington University Symposium; November 16, 2002; Chicago, Ill. Sx ? 2 h 0.0 Death Sx ? 2 h 5.0 7.5 2.5 Pre-hospital Lysis Primary PCI 2.2 5.7 Death P=0.057 0.0 7.5 10.0 2.5 Pre-hospital Lysis Primary PCI 5.9 3.7 Death P=0.47 5.0 Percent


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Материалы МУЗ МКБ СМП № 2 за 2005 г


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Зависимость летальности от возраста 125 29 353 24 6.8% 23.2%


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Эффективность тромболизиса в зависимости от возраста


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Увеличение летальности у больных РЕ-ИМ


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Кривые Каплана-Мейера выживаемости больных Ре-ИМ


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Summary: Selection of the Optimal Reperfusion Options for the STEMI Patient: 2004 Full Dose Fibrinolytic Monotherapy Door to balloon (D-B) > 90 min Lack of access to skilled PCI center (D-B) – (D-N) > 1 h < 3 h from symptom onset Invasive Strategy Cardiogenic shock (age < 75) Bleeding risk Diagnosis in doubt (pericarditis/aneurysm) Door to balloon < 90 min Skilled PCI center available, defined by: Operator experience > 75 cases/yr Team experience > 36 primary PCI/yr Age > 75 Symptoms > 2-3 h


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