2001 12 29 12 Chin J Cardiol December 2001 Vol. 29 No. 12 711 (30 min 90 min ST ) (2) AMI T + 2 1 AMI 1 AMI (2) ST (ST T ) ( ) (3) (AST) (CK) (CK2MB)

710 2001 12 29 12 Chin J Cardiol December 2001 Vol. 29 No. 12 20 (AMI) AMI AMI (ACC/ AHA) 1999 AMI AMI () ST ST AMI 10 min 18 ( 12 30 min 90 min ACC/ (PTCA) AHA () AMI I () AMI II AMI 1 1. AMI IIa () () IIb () 20 min () III () AMI 2. 18 10 min 18 100037 AMI V 7 V 9 V 3R V 5R ) ST AMI 91 % 46 % 18 (1) ST

2001 12 29 12 Chin J Cardiol December 2001 Vol. 29 No. 12 711 (30 min 90 min ST ) (2) AMI T + 2 1 AMI 1 AMI (2) ST (ST T ) ( ) (3) (AST) (CK) (CK2MB) AMI AMI ( ALT > AST) () AMI CK2MB I 1. AMI (ctni) T (ctnt) (1) (2) 2. AMI 1 3 CK CK2MB AST ctni ctnt (h) 12 24 24 6 34 612 100 % (h) 48 812 812 812 (h) 48 1024 1024 24 1024 2448 (d) 0151 510 514 34 24 35 3 (ALT) AST > ALT CK CK2MB AST (3) ctnt ctni

712 2001 12 29 12 Chin J Cardiol December 2001 Vol. 29 No. 12 AMI CK2MB CK AMI 2 AMI AMI AMI AMI 24h 69h 1224h AMI (1) (2) 1 (016mg) 5 min CK2MB 3 AMI 24h AMI 18 ST ( > AMI [ 70 ) ( < 100mm Hg 1mm Hg = 0. 133kPa) ( > 100 / min) ] ST ST AMI AMI ST 1020 min Q 1 18 ST 2 ST AMI 30 min (CCU) 90 min PTCA ST AMI ST 30 % ctni ctnt Q ST AMI CK2MB CK () ctni ctnt AMI AMI 50 % 1h AMI 1. AMI 2. (1) (2) AMI 13d

2001 12 29 12 Chin J Cardiol December 2001 Vol. 29 No. 12 713 3. 4. AMI AMI 3mg 612h ST 5 min 1 15mg 3 min (1) 014mg( 3 ) 5. AMI 012 mv 011mV) AMI / ( ST ) < 12h < 75 (ACC/ AHA I ) ( < 100 mm Hg) ( > 100 / min) 6. AMI ST 75 2448h AMI 75 75 75 AMI 1 000 10 (ACC/ AHA IIa ) ( < 90mm Hg) ( < 50 / min) ( > 100 / min) ST (ACC/ AHA 7. AMI IIb ) 150 > 180mm Hg 300mg 8. 9. AMI AMI ( ) 015110mg 35 min < 215mg ( < 015mg) PTCA (ACC/ AHA 101 AMI IIb ) ST > 24h AMI ST (ACC/ AHA III ) () 1. 20 80 1 ST AMI 6h ST ( ST 1224h () > 110mm Hg 150/ 90mm Hg (2) (24 ) ( )

714 2001 12 29 12 Chin J Cardiol December 2001 Vol. 29 No. 12 ( > 180/ ( ) Weaver 110mm Hg ) 10 PTCA [ (2 606 AMI ) 30d ( INR) 23 ] (24 ) 1119 % P < 0101) PTCA ( > 10 min) (017 % vs 210 % P = 01007) ( < 3 ) ( < 2 ) PTCA ( 5d2 ) revascularize occluded coronaries for cardiogenic shock? gλϖ gλω (3) ) 6 150 (5013 % vs 6311 % P = 01027) U 30 min < 75 1514 % ( P = 0101) 7 50010 000U 12h 75 2 a. ST 150 U AMI PTCA 1h 7 50010 000U 12h 2 12h (rt2pa) 12h (GUSTO ) PTCA(ACC/ AHA I ) 15mg 30 min 90 min 0175mg/ kg( 50mg) 60 min PTCA > 30 / 015mg/ kg ( 35mg) PTCA > 100 / 5 000U 1 000U/ h aptt aptt 6080s PTCA TUCC(rt2PA and urokinase comparison in China rt2pa ) 50mg rt2pa(8mg AMI < 75 42mg 90 min AMI 36h ) 90 min 18h PTCA (ACC/ AHA (7913 % vs 5310 % P = 01001) c. 2. (TIMI) 3 PTCA ( 414 % vs (011 % vs 111 % P < 01001) PTCA AMI SHOCK ( Should we emergently?) AMI PTCA ( PTCA PTCA AMI PTCA 90 % (CABG) 85 % b. ST / Q I ) PTCA (ACC/ AHA IIa ) (1) PTCA PTCA d. AMI ST ( IRA) ( TIMI 2 ) 12h

2001 12 29 12 Chin J Cardiol December 2001 Vol. 29 No. 12 715 ) PTCA(ACC/ AHA IIb a. AMI infarction ) PTCA b. 12h 1 EF PTCA c. PTCA PTCA AMI Zwolle 710d STENTPAMI (Stent primary angioplasty in acute myocardial infarction () ) CADILLAC (Controlled abciximab and device investigation to lower late angioplasty complications ) PTCA PTCA (bail2out stenting) AMI (2) PTCA PTCA PTCA52 ( isosorbide252mononitrate ISMN) RESCUE( AMI PTCA) 151 ( TIMI AMI 01) PTCA 2448h AMI PTCA 30d ( EF) ( 45 % vs 10g/ min 40 % P = 0104) IIIIV 510 min 510g (614 % vs 1616 % P = 0105) ST 30mm Hg TIMI 02 90mm Hg PTCA 12h 100g/ min AMI (1848h) PTCA ( CABG ) TAMI( Thrombolysis and angioplasty in myocardial (90 min) 710d PTCA 18 % PTCA PTCA 11 10mm Hg (3) PTCA 2448 h 24h 24 h PTCA TIMI IIA (Thrombolysis in myocardial infarction IIA 27mg/ h IIA) (2h ) 30g/ min 30 min

716 2001 12 29 12 Chin J Cardiol December 2001 Vol. 29 No. 12 5-1020mg 3 4 5-2040mg 2 ST AMI ST AMI AMI ( 90mm Hg) ( > 100 / min) 5 000U 1 000U/ h 4 6h 1 aptt ACT 21 115210 AMI 4872h 7 500U 12h 23d AMI (clopidogrel) (1) AMI A 2 ( A2 TXA2) rt2pa 10 % 5 000U 1 000U/ h 48h aptt ACT 70 % 12h ( ) 48h 7 500U AMI 2 23d 150300mg/ d V VIII 3d 6h aptt 50150mg/ d (2) (clopidogrel) ADP 2448 h 35d 250mg 2 12 X (1) ACT aptt 2 (70s) 250mg 1 (AMI ) (2) AMI 4 0006 500 Xa 24 IIa 1 Xa ADP ESSENCE ( Efficacy and 300mg 75mg/ d safety of subcutaneous enoxaparin in non Q wave coronary 31 events Q ) TIMI 11B FRAXIS( Fraxiparin in ischemic syndrome )

2001 12 29 12 Chin J Cardiol December 2001 Vol. 29 No. 12 717 AMI ACEI AMI ACEI ACEI AMI < 90mm Hg ( 41 ACEI 61 AMI AMI Q Q 2 2 25 50mg 2 3 612525mg 2 AMI AMI (1) Q AMI 5mg/ 5 min 12 AMI 2 AMI 10mg (5 min ) 515 < 60 / g kg - 1 min - 1 min < 100mm Hg 55 / ( Killip III ) PR min > 0124s 48h AMI AMI 51 (ACEI) ACEI ( 90mm Hg) (2) AMI ISIS24 ( International study of infarct survival24 24) GISSI23 ( Gruppo Italiano per lo studio della streptochinasi nell infarto miocardico23 71 AMI 24h 23) SMILE(Survival of myocardial infarction long term evaluation ) CCS - 1 (China cardiac study21 21) AMI ACEI AMI ACEI AMI 6 014mg ACEI 012014mg ACEI 81 6125mg 1215mg 25mg 121525mg 2 3 46 > 265mol/ L) AMI AMI 24h AMI ACEI (1) AMI

718 2001 12 29 12 Chin J Cardiol December 2001 Vol. 29 No. 12 1984 1991 7 AMI 1991 ISIS24 PCWP CO CI AMI ( ) AMI (1) AMI QT (2) - - ( GIK) ( ) 20mg AMI 1962 10g/ min ECLA ( Glucose insulin potassium pilot trial 2 2 ) ACEI ACEI GIK(25 % + 50IU/ L + 80mmol/ L 115ml kg - 1 h - 1 24h) GIK(10 % + 20IU/ L + 50mmol/ L 1ml kg - 1 h - 1 ) AMI 24h AMI AMI GIK 90110 () 11 AMI (2) AMI < 80mm Hg (SV) (CO) AMI AMI ( PCWP) > 18mm Hg AMI (CI) < 215 Lmin - 1 m - 2 85 % PCWP > 18mm Hg CI < 212 Lmin - 1 m - 2 AMI < 80mm Hg CI < 118 Lmin - 1 m - 2 PCWP > 20mm Hg AMI X AMI AMI 12L (35g kg - 1 min - 1 ) Killip 10 %15 % 90 mm Hg ( 10g/ min) / min

2001 12 29 12 Chin J Cardiol December 2001 Vol. 29 No. 12 719 515g kg - 1 min - 1 90mm Hg (3 10g kg - 1 min - 1 ) 12L ( 15g kg - 1 min - 1 ) 1 28g/ min AMI 31 ( IABP) AMI IABP 83 %IABP ( PTCA CABG ) IABP ( ) ( PTCA CABG) (1) AMI 20 %50 % AMI PTCA CABG AMI PTCA 70 %AMI PTCA a1 ( ) CABG b1 a1 AMI b1 AMI 215 5mg 5 min 15 min 21 15mg < 100mm Hg < 60 / min 10 %15 % ( V 4R ) ST 011mV 12h Kussmaul ( ) 510mg (01075 0175mg/ kg) 30 min

720 2001 12 29 12 Chin J Cardiol December 2001 Vol. 29 No. 12 c1 (2) AMI AMI < 50 / ( min R on T ) 015mg 35 min 60 / min 2mg 14 AMI 015mg 9 063 a1 QRS AMI b1 QRS AMI ( c1 ) 200 J d1 300 J ( < 90mm Hg) e1 50mg a ( 1520 min 150mg 24mg/ min 24h 150mg 10 min c 1mg/ min 6h 015mg/ min ( 24h) 41 AMI QRS ) b d ( > 3s) AMI AMI QT Q (3) 30 %40 %AMI (1) (Bezold2Jarish ) 2 6 %14 %

2001 12 29 12 Chin J Cardiol December 2001 Vol. 29 No. 12 721 31 (2) AMI 3 4 50 % ST ST IABP (ACS) 80 %90 % ( ) 6 TIMI IIIB (3) AMI AMI 1. ( GP) IIb/ IIIa GP IIb/ IIIa GP IIb/ IIIa GP IIb/ IIIa () 3 ( abciximab IABP ReoPro) GP IIb/ IIIa Fab ( eptifibatide integrilin) (tirofiban) EPIC ( Evaluation of ST AMI 7E3 for the prevention of ischemic complications 7E3 () ST AMI ) IMPACT2II ( Integrilin to ST AMI Q AMI ST AMI 2II) (20 %40 %) CAPTURE ( C7E3 fab antiplatelet therapy in unstable ST refractory angina C7E3 ) RESTORE ( Randomized efficacy study of ST AMI tirofiban for outcome and restenosis ) 3 ST AMI ST AMI ACS ACS SYMPHONY I II ( Sibrafiban vs aspirin to yield maximum protection from ischemic heart events post acute coronary syndromes I II ACS 1 1 ST ACS 1mm ST > 1mm () ST AMI ST minimize platelet aggregation and thrombosis2ii I II) 21 2. ( ESSENCE ST TIMI IIB FRAXIS) ST ACS

722 2001 12 29 12 Chin J Cardiol December 2001 Vol. 29 No. 12 (4) ST2 T ST () ST AMI UCG 21 ST AMI ST AMI ST (PET) PET IABP () AMI 31 11 (1) ( ( ) ( 1014d) S 3 ) ( ( 1021d) ) ST ST UCG EF 1 5 > 130 ml EF < 40 % (METs) ST 41 1 (2) ( ) (UCG) QRS (3) AMI (HRV) 201 Tl 99m TC2MIBI

2001 12 29 12 Chin J Cardiol December 2001 Vol. 29 No. 12 723 4S ( Scandinavian ( > 90 %) simvastatin survival study ( < 30 %) ) CARE(Cholesterol and recurrent events ) LIPID (Long term intervention with pravastatin in ischemic disease () ( ) PTCA CABG AMI 40 %) (22 %30 %) PTCA CABG ( ) ( EF < 40 %) (60 ) ( ) PTCA CABG 1. PTCA HDL2C ( TG) LDL2C TG PTCA ( PTCA) [2126 mmol/ L (200 mg/ dl) ] HDL2C PTCA VA2HIT ( Veterans affairs high desity lipoprotein cholesterol interventional trial ) HDL2C 2000 HDL2C HDL2C PTCA 2. AMI PTCA (1) TG1169 mmol/ L (150 mg/ dl) (2) (NCEP) PTCA ) (LDL2C) (30 % ( HDL2C) 1104 mmol/ L (40 mg/ dl) 24h (3) 4 PTCA (1) AMI AMI ( 7 % < 200 mg/ d) (2) ( TC) > 4168 ( mmol/ L (180 mg/ dl) LDL2C > 3112 mmol/ L (120 mg/ ) dl) LDL2C 2159 mmol/ L (100 mg/ dl) 11 A (3) HDL2C < 0191 (HMG2CoA) 3 mmol/ L (35 mg/ dl)

724 2001 12 29 12 Chin J Cardiol December 2001 Vol. 29 No. 12 (40 mg/ dl) HDL2C 1104 mmol/ L (4) TG < 1169 mmol/ L (150 mg/ dl) 2126 mmol/ L (200 mg/ dl) LDL2C HDL2 C 21 2615 % 2211 %( P = 0100001) SOLVD ( Studies of ventricular dysfunction ) 4 228 EF < 35 % ( ( 80 % ) 20 % ) ACEI EF < 40 % HOPE ( The heart outcomes prevention evaluation study ) 5 AMI 1715 % 1319 % 22 %( P = 01000 002) ACEI < 75 (1) > 100mm Hg (2) ST ACEI ( 150 mg/ d 3. d) ACEI 50325 mg AMI Q AMI 50150 mg ( 250 mg 1 ) AMI CAPRIE ( Clopidogrel vs aspirin in patients at risk of 817 %( P = 01043) 4. (ACEI) ACEI AMI 411d 40 mg/ d 10 mg/ d 10 mg/ 5. ischemic events ) 6. 2 (

2001 12 29 12 Chin J Cardiol December 2001 Vol. 29 No. 12 725 ) 7. 50 % EMIAT (The European myocardial infarction amiodarone trial ) CAMIAT ( Canadian amiodarone myocardial infarction arrhythmia trial ) ( ) ( ) 22 %47 %3 7 %47 % () ( 2001210208) ( ) 60 % 2002 7 17 20 1. 2 21 31 41 51 6. 7. ( ) 8. GCP 9. 10. 2002 4 28 42 100710 (010) 65249989 1309 2311 ( )