ACCF/SCAI/STS/AATS/AHA/ASNC ???? ????????????? Appropriateness Creteria for Coronary Revascularization

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ACCF/SCAI/STS/AATS/AHA/ASNC ?????????????????Ap
propriateness Creteria for Coronary
Revascularization

• ????????????
• ???

2
????????

• American College of Cardiology Foundation
  Appropriateness Creteria Task Force
• Society for Cardiovascular Angiography and
  Internation
• Society of Thoracic Surgeons
• American Association for Thracic Surgery
• American Heart Association
• American Society of Echocardiolograghy
• Heart Failure Society of America
• Society of Cardiovascular Computed Tomography

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17-member technical panel

• 4 Interventional Cardiologists
• 4 Cardiovascular Surgeons
• 8 members representing Cardiologyists
• Other physicians who treat patients with
  physicians who treat patients with
  CVdisease,Health outcome researcher
• 1 medical officer from a health plan

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????????????

• OVER-USE
• UNDER-USE
• CABG
• PCI unbalanced

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???????

• ?180?????????
• ?ACC/AHA/ESC?????????????

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??????

• ????
• ACC/AHA/ESC??
• ????

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????
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????????

• ????(ACS,?????,?)
• ?????(????CCS??I,II,III,IV?)
• ??????????,??????,??????,??????????
• ??????
• ??????(1-,2-,3-?????,??????????????)

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UA/NSTEMI?????????MI???????

• ????1?
• 48?????????????
• ??????gt20??
• ??
• ???
• ???????????
• S3???/????
• ???.????,????
• ??gt75?
• ???
• ????????ST???gt0.5mm
• ???????????????
• ?????????

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CCS?????

• I?
• ?????????,?????????
• II?
• ??????????.??2?????2????????
• III?
• ??????????,1-2?????1??????
• IV?
• ??????????????????

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????????

• ?????????3/?
• ?????????1-3/?
• ?????????1/?

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??

• ??LVEFlt35????LVEFlt35
• ??????????(-11?)
• SPECT??
• ?????????????(????)?
• ??????????????????TI-201??
• ??????????????????(10mg/kg/min)???lt120?/?????????
  ??????????
• ???????????????

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??

• ??LVEF 35-49
• ??????????(-11-5)
• SPECT??????????????????????TI201??
• ???????????????????2????????????????????

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??

• ????????(5)
• SPECT?????????????????
• ?????????????????????????????

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??

• ?????????2??????
• ??????
• ????????50-60
• ????????
• ???????50
• ????????70
• ?????????????????
• ??????????PCI?CABG

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?????????????????
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ACS????????(PCI/CABG) ???
Patel, M. R. et al. J Am Coll Cardiol
200953530-553
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STEMI????????????

• STEMI??12??,???????????????,??????????
• ????PCI????,???????????????,????????LVEF??,???????
  ?????????

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????????????(PCI/CABG)???
A ?? U ??? I ???
Patel, M. R. et al. J Am Coll Cardiol
200953530-553
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???????CCSI-II??? ????(PCI/CABG)???
A ?? U ??? I ???
Patel, M. R. et al. J Am Coll Cardiol
200953530-553
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???????CCSIII-IV??? ????(PCI/CABG)???
A ?? U ??? I ???
Patel, M. R. et al. J Am Coll Cardiol
200953530-553
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??????????????????

• ???????????????
• ????2???(???LAD??)?1?CTO,?????????,????,?????????,
  ???1-2?,???????????,???3????????????????
• ???????????????,??????????????,?????????,???2???,?
  ??????????,???3????????????

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??????????????????

• ????2???(???LAD??)?1?CTO,????????????????,????????
  ??????,?????????,??????????????,??????,???????????
  ??

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??????????????????

• ??????????????,???????????,????????,???????,??????
  ??????
• ?????????????????????????

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??????????????????

• ??????(50-60),FFRgt0.75?IVUS????????,???????
• FFRlt0.75?/?IVUS???????,???????????,???1-2?????????
  ???,???3??????????

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??????? PCI VS CABG ??
A ?? U ??? I ???
Patel, M. R. et al. J Am Coll Cardiol
200953530-553
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??CABG??????

• ??????????LVEF??????????
• ??????,???????
• ??????(PCI?????????)
• ?????????????
• ???????

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??PCI??????

• ????????LVEF????????
• ??????,???????

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PCI??????

• ????????LVEF????????
• ?????????????
• ???????

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????????

• ???????????????
• ???????????
• ????????????????

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Stent use in CHINA
DES use 90 ,partially 100
2007
2002-2005
1997-2001
1996
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??2006?PCI?CABG????
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??2006?PCI?CABG????
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??CABG??????PCI????
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??!