Historic Studies and New Perspectives on AMI Treatment

AMI治疗历史性回顾和前瞻性研究

要点：
 TCT会议回顾了近30年AMI介入治疗的历程

为了纪念TCT20周年，Renu Virmani讨论AMI病因学的发展历程，Eugene Braunwald概述了AMI介入治疗的历史，并指出了一些取得新进展的标志性研究。

     Virmani提到1999年Arbustini的研究，该研究表明女性比男性更易发生斑块破裂和侵蚀。

      一项发起于2000年的研究中，Virmani和她的同事们比较了AMI尸检的心外膜病变，报道说大多数AMI血栓发生是由于斑块破裂，而不是侵蚀。这一结果通过分析心外膜病变得到进一步证实。

Key Points:

• TCT session encapsulated 30 years of interventional AMI therapies.

By TCT Daily Staff

To mark the 20^th anniversary of TCT, Renu Virmani, MD, of the CVPath Institute, Inc., in Gaithersburg, Md., discussed evolving perspectives on the etiology of AMI over time, while Eugene Braunwald, MD, of Brigham and Women’s Hospital in Boston, summarized the history of interventional AMI therapies and pointed to a number of hallmark studies that have led to new advancements.

Virmani (left) referred to a study by Arbustini et al in 1999 that showed that plaque rupture and erosion is more common in women than in men.

In a study from 2000, Virmani and her colleagues compared the epicardial culprit lesions in cases of AMI at autopsy, reporting that the majority of thrombi in AMI occurred due to plaque rupture and not erosion. This finding was further confirmed upon analysis of epicardial culprit lesions.

In the study, plaque erosion was more common than plaque rupture in women younger than 50 (see Figure). Plaque rupture, meanwhile, was found to occur more frequently in men under the age of 60, whereas in women, plaque rupture occurred beyond the age of 50. No significant differences were found between white and black populations.

Virmani next referred to a study by Burke et al published in 2001, which showed that the mean percent stenosis increases with the number of prior rupture sites, suggesting that plaque ruptures lead to plaque progression.

In another study by Kolodgie et al published that same year, intramyocardial emboli were shown to be more common in plaque erosion than plaque rupture.

Landmark studies give context to new developments

Braunwald took TCT attendees back in time, touching on the most important findings in the history of AMI studies. Beginning with the 1935 study titled "The Effect of Coronary Occlusion on Myocardial Contraction" by Robert Tennant and Carl J. Wiggers, Braunwald chronologically described advancements in AMI therapy, ending his presentation with the 1993 study titled "Prehospital Thrombolytic Therapy in Patients with Suspected Acute Myocardial Infarction" by the European Myocardial Infarction Project Group. Braunwald’s presentation diagrammed the building of new research models from past results and illuminated the progress made possible by research and analysis, a notion familiar to the TCT community.

Disclosures:

• Dr. Virmani reports no relevant conflicts of interest.
• Dr. Braunwald reports no relevant conflicts of interest.

（source：www.tctmd.com）