1
2012 2
ST 2013 acute coronary syndrome: ACS ST ST 3 3 ST ST 2012 ST 5 2011 12 percutaneous coronary interventionpci magnetic resonance imaging MRI universal definition 99 1) ST ST 12 ST ST 90 2002 2012 3
2012 ST ST I II IIa IIb III A400 B400 C 2013 12 Davies 2) Fuster 3) acute coronary syndromeacs ST ST-elevation acute myocardial infarctionstemi 4
ST 2013 5
2012 1979 4) 1980 DeWood 5) Kodama 6) 92 Asakura 7) T vulnerable plaque 8,9) calcified nodule calcified nodule 10) positive remodeling T T 10) 11) optical coherence tomographyoct 12) 13) OCT fibrous cap thin fibrous cap fibroatheroma TCFA 14) 7) vulnerable patient 15) 40 16) 17) universal definition 1 2 1) 6
ST 2013 STEMI hypokinesis akinesis dyskinesis 18) dp/dt 19) 1 Frank-Starling 20) angiotensin converting enzymeace 21) BNP 22) STEMI 6 3) 35 24 Hurler Fabry CO DIC 23) 17,24,25) 26,27) 5055 3436 54 28,29) 1980 1990 2 NIPPON DATA National Integrated Project for Prospective Obser vation of Non-communicable Disease And its Trends in the Aged 30) HDL 135 mmhg 85 mmhg 2 7
2012 1.5 31) 32) 2.6 33) 34) 35) 36) 37) 2 10 14 38) 39) LDL 40,41) 55 65 42) J-LITJapan Lipid Intervention Trial 43) 44) CKD 45) CKD 46) CKD 47) Ni-Hon-San 48) 49,50) 51) 52) 19902001 100.7 35.7 53) 19941996 41.9 5.3 54) 10 10100 55) 824 508 314 270 1998 2008 10 274 208 STEMI 56) 1990 1998 80 53) MIYAGI- AMI Registry 1979 2008 30 57) 30 2003 OASIS 7.1 28) 2005 HIJAMI 9.4 29) MIYAGI-AMI Registry 1979 20 2008 8 57) CCU 1982 20.5 2000 6 58) 8
ST 2013 29) STEMIcoronary care unitccu 7 59) STEMI CCU 10 2005 25.92010 20.4 11.5 8.4 STEMI 14 60-62) STEMI 63,64) door-to-balloon time onset-to-device time onsetto-device time STEMI 20 2 5 3 66-68) ACC/ AHA2004 1 5 STEMI CCU 81 6 4 65) STEMI STEMI STEMI 14 ventricular fibrillationvf VF 60 61) automated external defibrillatoraed 12 69) AED 1 710 AED 62) AED 9
2012 119 cardiopulmonary resuscitationcpr CPR CPR CPR 70,71) 2010 ILCOR CoSTR AHA CPR BLSbasic life support CPR AED STEMI 66-68,72) 119 119 30 119 9 73,74) AED 1 mg/ 12 4 73,74) 73,74) 10
ST 2013 12 IV. 14 STEMI 75-77) 0.8395 CI 0.70 0.98 60 78) AHA CPR/ECC 2010 PCI 90 79) Watanabe TIMI 3 78 80) Nakao 2 facilitated PCI TIMI 3 81) Kimura primary PCI 90 TIMI 3 68 primary PCI 43 82) 30 PCI 2 PCI 83, 84). AHA/ACC ST /PCI 2009 PCI primary PCI PCI PCI PCI 85) 11
2012 STEMI PCI CABG STEMI TIMI 3 120 PCI 12 86,87) 12 CCU 24 CCU STEMI 12
ST 2013 88) STEMI STEMI PCI CABG CCU CCU 13
2012 STEMI 10 89-91) 12 STEMI 30 PCI first medical contact 90 89-94) STEMI 95-98) 20 14
ST 2013 97-99) 100) 97,98) Ca 101) 15
2012 3 Bezold-Jarisch 90 mmhg III III Killip 102) thrill 4 23 III Killip 102) STEMI Stanford A 5 16
ST 2013 STEMI 103) 104,105) Thyperacute T T R ST Q STEMI 106) 510 V4R V4R 1mm 0.1mV ST ST 10 ST 107) STEMI ST ST 108,109) ST V1V4 ST V7V9 ST 50 40 ST T 10 110-113) ST 114) V1V3 ST QS ST avr ST PR avr ST PR WPWWolff- Parkinson-White 2 ST-T QRS 1mm ST V1V3 1mm ST QRS 5mm ST STEMI 115) V1 V3V4 ST qr V1 rr R 116) avr ST V1 ST 117). 12 Cabrera sequence 118) avl I avr avr III II Cabrera sequence 12 STEMI 119) STEMI 12 17
2012 120,121) 12 2000 12 primary PCI PCI 122-126) 12 STEMI 127-130) STEMI 131) creatine kinaseckmbck-mb H-FABP TI T 6 STEMI 1218 1 90120 2 2 1 I 132) CK 133,134) 135) STEMI 38 1024 36 CK CK 99 CK ESC/ACCF/AHA/WHF universal definition 136,137) 2 138) 2 139,140) H-FABP H-FABP H-FABP 2 141) 142) 18
ST 2013 X X X X X 53 90 143,144) echo free space diastolic 19
2012 collapse Doppler intimal flap STEMI STEMI 12 145-148) Killip 102) Killip IV 4070 149-151a) 30 90 mmhg 90 mmhg SHOCK Registry 9 6 47 24 74 151b) GRACE TIMI GRACE Killip ST STEMI 6 152,153) GRACE GRACE 100 101120 121140 141 3.9 2.0 6.3 11.8 16.8 154) TIMI 8 155) GRACE TIMI simple risk indexcadillac simple risk index /10 2 156) CADILAC PCI Killip 3 PCI TIMI 7 157) STEMI 20
ST 2013 158) 159) 6 100 25 L/ CO2 160) 161) 162) 35 3 90 mmhg 30 mmhg50/ 100/ 24 163) 24 mg 515 28 mg 21
2012 0.10.2 mg 2.55.0 mg 164-171) STEMI 162325 mg 81 mg 2 4 100 mg 23 PCI 2 loading dose300 mg 172,173) 600 mg 174) 75 mg/ 85,175,176) 75 177) PCI ACT 250 2 TIMI 2 178) tpa 179,180) tpa APTT 5070 48 V. 32 181,182) 22
ST 2013 heparin-induced thrombocytopenia: HIT 183,184) immune-mediated HIT II HIT 1 HIT 185) HIT HIT 186) 187-191) 2 192) PCI 12 193) 194) PCI 195) 1 1 196,197) VI. 38 PCI STEMI 6 5) Fabry Hurler 23
2012 CO DIC 23) Stanford A 39 STEMI Marfan B A X STEMI intimal flap CT intimal flap A 198) STEMI 40 199, 200) 91 44 STEMI 14 200) 23 200) coronary artery bypass graftingcabg 201) intravascular ultrasound IVUSOCT ST universal definition 2 1) 0.061.1 202-205) 202) Prizel 49 29 24 5.5 205) 5668 1233 6.824 206) 207,208) PCI 1970 universal definition 2 1) 24
ST 2013 209) 210) Ueda 211) STEMI A 212) 213) P- 214) 1121 215,216) 69 17) 714 24) 80 37 50 14 64 17 20 7 STEMI STEMI Ca STEMI 35 24 3) Fabry 23) STEMI PCI 64,72) first medical contact door-to-needle time 30 PCI first medical contact door-to-device time 90 PCI PCI 3 PCI 217,218) PCI PCI PCI 60 PCI 60 94) 25
2012 PCI PCI STEMI 219) 60PCI 3 PCI 217,218) STEMI PCI PCI 219) 10 57,220) PCI universal definition STEMI ST 26
ST 2013 6 180/110 mmhg 10 3 24 24 75 12 24 ST PCI 1375027500 /kg TIMI 2 PCI 27
2012 60kg 1 80 10mL 1 PCI PCI PCI primary PCI 151a,217,218,221-238) 239-241) STEMI PCI PCI 3 PCI PCI STEMI STEMI primary PCI 24 primary PCI PCI STEMI primary PCI 242,243) STEMI 244,245) 28
ST 2013 2 246) primary PCI no reflow 249-252) TIMI 253) 254,255) no reflow STEMI 6 1 75 151a) 75 150,247,248) 12 STEMI primary PCI 12 ST primary PCI 29
2012 PCI facilitated PCI rescue PCI facilitated PCI PCI PCI PCI rescue PCI PCI STEMI 2 PCI PCI PCI PCI systematic PCI systematic PCI 83,84) systematic PCI primary PCI 256,257) PCI PCI 83,84) PCI CABG STEMI CABG 3.210.9 258,259) CABG CABG 258,260-266) 267) STEMI CABG 48 CABG 266,268) CABG primary PCI CABG 30
ST 2013 CABG CABG 151a, 269-271) CABG CABG 272) ST 273) CK CK-MB MB 6090 510 274) 60 90 rescue PCI 275) primary PCI TIMI PCI TIMI 2 TIMI 3 276) TIMI frame count 277) TIMI 3 no reflow 1/4 278) myocardial blush grade blush 279,280) 281) primary PCI ST reperfusion arrhythmiast myocardial stunning 282) 283) 284) remote ischemic conditioning 285) 31
2012 290-293) 294, 295) STEMI PCI primary PCI ACC/ AHA2009 70100 /kg ACT 250 85) 286) ACT APTT 287,288) 6 3 HIT 289) 10 HIT I II I 23 1020 II PF4HIT 514 50 STEMI 296) HIT PCI 297) HIT 2011 HIT PCI PCI 0.1 mg/kg 35 4 6 g/kg/ 10 ACT 4 ACT 250 450 298) 4 0.7g/kg/ APTT APTT 1.5 3 3 4 0.2 g/kg/ 10 Xa OASIS- 5 Fifth Organization to Assess Strategies in Ischemic Syndromes ST ST PCI 299) 32
ST 2013 OASIS-6 STEMI 300) primary PCI 175) III Xa Xa STEMI 301) 172,176,302-304) 2012 J-AMI STEMI 300 mg/ 75 mg/ 304) STEMI 172,176,302,304,305) 600 mg ACC/AHA 300 600 mg 306-308) ACC/AHA STEMI ACC/AHA 1 85) j-cypher 6 6 2 309) 1 5 310) 12 2 dual anti-platelet therapy DAPT proton pump inhibitorppi 311,312) PPI PPI 313-315) PPI PPI 316-318) PPI H2 319) DAPT III primary PCI 320) 321) 33
2012 A reperfusion injury salvage kinase 0.025g/kg/ 3 HayashiKasama ST 322,323) J-WIND-ANP 569 PCI 0.025g/kg/ 3 CK 14.7 5.1 2.7 324) ATP KATP KATP NO PCI Ito PCI 4 mg 24 6 mg/ no reflow 325) Ishii primary PCI 30 12 mg TIMI frame count ST resolution 326) Iwakura 327) PCI TIMI 3 no reflow 328) 329) 2 mg 30 J-WIND-KATP 0.067mg/kg 24 1.67g/kg/ CK 324) AMISTAD 330) 331) primary PCI 332,333) EPO-AMI 34
ST 2013 II 334) STEMI PCI 282,335) 336) 337) STEMI 624 PCI 2 338,339) PCI 338,340) 273,341) 342) 340) ST PCI TIMI 0 343) primary PCI 344) primary VF 345) STEMI 72 0.5 mg/ dl 25 346) 27 1.5 mg/dl 510 347) Cigarroa 5 mlkg300 ml/ mg/dl 348) Gurm /Cockcroft-Gault 349) 222.9 3 3 2 350) risk-benefit IABP 351,352) 35
2012 353-355) N- 356) 357) 358) PCI 359-361) 362) 363) 364) 48 346) STEMI CCU CCU 1962 Day 365 Kansas Bethany Philadelphia Presbyterian Toronto 1968 coronary care unit CCU cardiac care unit circulatory care unit CCU chest pain unit chest pain center 366,367) CCU 368) CCU PCI CABG 300 CCU 369) CCU 370) Swan- Ganz 371) 372,373) CCU 36
ST 2013 CCU 369) Swan-Ganz pulmonary capillary wedge pressure: PCWP cardiac indexci 48 CK 6 6 12 138,374,375) CCU PCI 1 376) PCI 6 79) 377) VII. 67 CCU 2 CK 2 PCI 800 kcal/ 6 g/ 378) 1 CCU 379 380) 381) 382) 200 mg/dl 383,384) 385) CCU 386) Foley 387) 388) 37
2012 389) 390) A CCU CCU 391) 3 PCI 396) no reflowpci CCU :. Killip 145) CKD T I brain natriuretic peptidebnp N NTproBNPST STEMI 392,393) primary PCI 394,395) STEMI primary PCI 20 STEMI STEMI primary PCI STEMI REACH 397) primary PCI 38
ST 2013 STEMI 40 193,398) 2448 ACE 2011 399) 81162 mg/ STEMI 171,293,400) 75 mg/ 300 mg/ 171) STEMI PCI PCI 300 mg 75 mg/ 302) 28 176) ACC/AHA 12 39
2012 85,303,304) 12 7.4 33 172,305) 401) DAPT2 402) PT-INR 2.0 LDL 403-405) MUSASHI- AMI 406) LDL IVUS ESTABLISH 407) JAPAN-ACS 408) Extended- ESTABLISH 409) LDL LDL 410,411) Ca STEMI Ca 412,413) 414) 415) 416) 198 mg/dl DIGAMI 40
ST 2013 277 mg/dl 24 172 mg/dl 417) 162 mg/dl 20201 GIK CREATE-ECLA 24 GIK 155 mg/dl 135 mg/dl 418) 35 8 27 419) NICE-SUGER 6104 81108 mg/dl180 mg/ dl 144 mg/dl 383) 40 mg/dl 6.8 0.5 p 0.00190 27.5 24.9 p =0.02 420) 41
2012 VF VFprimary VF 4 421-424) 24 425-427) VF VF secondary VF 50 12 VF PCI ICUCCU VF VF VF VF ISIS-3 345) III 428) 30 60 VF 429) VF 162) 58000 ISIS-4 4 VF VF VT 1 2 cardiopulmonary resuscitationcpr AHA ACLS2010 430) 120200 J 2 360 J 2 1 2 CPRVFVT 2 CPR 1mg 40 35 2 CPR3 CPR AHA 2010 430) 300 mg 5 mg/kg QT torsades de pointes K VF VT 431,432) VF VF VT 433,434) 42
ST 2013 435,436) VF VT CPR VF VT VF VT CPR CPR percutaneous cardiopulmonary support systempcps CPR percutaneous cardiopulmonary support system PCPS PCI 437) STEMI VF VT intra-aortic balloon pumpingiabpextracorporeal membrane oxygenationecmo PCI 43
2012 VT 30 VT 30 VT VT 48 48 VT 170bpm VT VT 438,439) wide-qrs tachycardia 12 wide-qrs tachycardia VT wide-qrs tachycardia VT VT VT VF VT 100J VT 430,440) VT AHA2010 430) 2 VT 125 mg 10 300 mg 6 450 mg 18 2 600 mg 24 VT VF 125 mg 10 1750 mg/24 VT 441-444) VT VT 44
ST 2013 VT 431,432,445) 0.15 0.3 mg/kg 5 0.4 mg/kg/ torsades de pointes 0.10.3 mg/kg0.10.4 mg/kg/ STEMI VT VF electrical storm 446-448) IABP PCl 449,450) VT 451) VT VF ph CAST Ic 452) STEMI Ic AIVR 12 VF 344,453) AIVR VF 2011 399) 45
2012 STEMI 65 20 454,455) 25.3 16 30 29.3 19.1 1 48.3 32.7 454) 454) 456) 200 J 120200 J 430) Ca 457) 458) 459) 2008 ESC 121) 2011 ACCF/ AHA/HRS 460) 2 10 mg 1 1 mg 0.060.125 mg/kg 10.01 0.04 mg/kg/ 10.1mL/ kg 1 mg/kg 30 100 mmhg 50/ 461) 462) Ca 60 6 ACE 455) CAPRICORN 5.4 2.3 463) VF PEA 464) 465,466) 467) PEA 30 468) PEA STEMI 3040 1 Ca 46
ST 2013 0.5 mg 5 3 mg 210g/ 210 g/kg/ 469). STEMI 614 STEMI 469). 470) 3 QRS 210g/ 210g/ kg/ 3 STEMI Mobitz II 2 STEMI 2 1 Mobitz I 2 STEMI 471-473). STEMI 47
2012 His- Purkinje STEMI 1 474) 2011 475) 1 476) STEMI 20 40 477) 1 extension Killip 102,478) STEMI 29,145,155,479) Swan-Ganz 480) Forrester 200 PCWPCI 4 hemodynamic subset 481) 48
ST 2013 ACE ARB IABP PCPS Nohria Nohria-Stevenson 482,483) Forrester 4 X 484) Swan-Ganz Swan-Ganz 5 485) 49
2012 primary PCI 486,487) noninvasive positive pressure ventilationnppv 488-490) pressure support ventilation : PSV positive end expiratory pressurepeep bilevel positive airway pressure : BiPAP continuous positive airway pressurecpap 491) 492) 35 mg 493) 90100 mmhg 20 mg V2 494) A ANP 495-497) PCI PAMI-II PCI IABP 498) PCI 3 IABP 50
ST 2013 499) 15g/kg/ IABP PCI CABG 500) 90mmHg30mmHg 20mL/ STEMI 1015 501) 30 X 502) Swan-Ganz 515g/kg/ 215g/kg/ 0.030.3g/kg/ IABP 503) PCPS 504,505). 2g/kg/ 2g/kg/ 5g/kg/ 1 2g/kg/ PDE- III 1996 1998 STEMI 3113 126 4 59 42 506) PCI CABG 152 150 2 30 6 1 SHOCK 30 46.7 56 6 1 53.7 66.4 p 0.03 75 30 150,151a) ESC IABP 2 51
2012 175) multiple organ failuremof systemic inflammatory response syndromesirs IAPB 507,508) ESC IABP Impella 509) 510) ACE 49 STEMI 1015 511,512) V4R 1mm ST Kussmaul 511) 513,514) Swan-Ganz 10mmHg PCWP 5mmHg y noncompliant PCWP 15mmHg PCWP 18mmHg 5001000 ml IABP 515) 516,517) CABG 52
ST 2013 6 4 513) STEMI 369,518a) STEMI 1 518b) Swan-Ganz IABP STEMI SHOCK Registry 55 40 71 519) STEMI 1 53
2012 518b) GUSTO-I 520,521) 35 GUSTO-I SHOCK Registry 24 521,522) 43 523) 40 Doppler Swan-Ganz STEMI 16 520, 524-529) ST-T PEA 24 35 2 Q 14 527,530) 14 526,531) 525,526) STEMI 7.2 18.8 532) PCI 54
ST 2013 24 CABG IABP 533,534) 521,535-542) Daggett 543) infarct-exclusion 544) 545,546) 547) blow-out 80 100mmHg 548) IABPPCPS 549-551) 552) oozing sutureless 553) 55
2012 554,555) 556,557) IABP STEMI IABP PCPS 1 left ventricular assist devicelvad PCPS STEMI ImpellaIABP 509) STEMI CK-MB MBH-FABP ST ST T pseudo-normalization 558) 7 PCI 3000 2.53 28,29) 45 181,524) 20 primary PCI 6 181,241) 559) 56
ST 2013 181,524,560) primary PCI PCI CABG 561,562) STEMI 563,564) STEMI ST 40 558) STEMI 565) Q oozing rupture 528) STEMI 1 T T T 566) CK-MB Doressler 567) 1 0.331.5g1 1.0 4.5g 568) 569,570) 57
2012 STEMI 0.751.2 561,571,572) STEMI STEMI 40 571) STEMI 561,573,574) 573,575) SAVE 574) Killip IIIIV 576) 577,578) STEMI 28 1 572) STEMI MRIMRA CT 579) STEMI 580) PCI 75 mg/ 12 81 162 mg/ 581) PT-INR 2 STEMI 3 3 579,582) distal protection device 583,584) 46 307 2002 585) 30 5.8 12.6 p 0.047 2009 586) 587) PT-INR 23 588,589) 590) 58
ST 2013 586,589) STEMI 588) 586) STEMI risk area avr ST V1 81 81 117) ST ST ST ST QRS avr ST 1mm ST 2.5mm0.25mV V1 ST V4V6 septal Q Seg.6 591) V5V6 2mm ST 592,593) III ST II I avl ST 594,595) IaVL ST avl II ST III V1V3 ST IaVL ST 596,597) Seg.4AV 12 V3RV6RV7V9 598) V4R 1mm ST V4RST 10 107) V4 V7 V8 V9 ST Q 599,600) 600) Q ST T 4 V7V9 ST 601) 12 1mm ST T Q 1 601) 59
2012 STEMI ST ST resolution ST resolution ST 602,603) ST resolution ST ST resolution 604) Q Q MRI Q 605) T 24 T Q T T Q T 606) Q Q R R 607) R Q 12 R Q R Q QRS 608) QRS CK CK-MB I T 609-612) T 7296 613,614) I T 72 613) 10 STEMI 139,140) 615) WPW ASE 16 6 6 4 616) normokinesis 1 hypokinesis2 akinesis3 60
ST 2013 dyskinesis4 aneurysm5 5 617) CK 618-620) 621) 622) 2010 623) IX STEMI 624) 201 Tl 625,626) 99m Tc sestamibi MIBI 99m Tc tetrofosmin 99m Tc 627-630) 631) 17 Berman 20 632) 5 uptake uptake50 99m Tc MIBI 83 69 201 Tl 633) 634) 99m Tc quantitative gated SPECTQGS QGS 635) 123 I-BMIPP SPECT 636,637) 201 Tl 123 I-BMIPP 638,639) 123 I-BMIPP SPECT risk area 99m Tc pyrophosphate CK 640) 641) 2010 642) MRIcardiac MRI:CMR MRIT2 MRI late gadolinium MRI: LGE-MRI MRI 643-647) 17 617) thickeningradial shortening 2005 MRI reference standard 648) CMR 61
2012 T2 LGE-MRI CMR LGE-MRI MRI 649-652) 652) CT single photon emission computed tomographyspect SPECT MRI SPECT CMR SPECT CMR SPECT 649) 48 653) 24 654,655) CMR 656) LGE-MRI 10 LGE-MRI 657,658) 659) LGE-MRI positron emission tomographypet 660) LGE-MRI 661) PCI CABG 1 LGE-MRI 25 3 662) 663) 664,665) 666) LGE-MRI 667) PCI 2050 slow flowno flow MRI microvascular obstruction MO CMR perfusion MRI LGE- MRI MO perfusion MRI 12 early MO 668) MO LGE-MRI 1015 late MO persistent MO 668) MO T2 T2 669,670) 78 671,672) 673) 62
ST 2013 STEMI 40 674) STEMI 674) PCI CABG PCI 2011 675) 2011 676) 3 SYNTAX 33 677) 4 CABG 3.3 PCI 9.0 678) 3 PCI CABG CABG 48 CABG 266,268) 2 primary PCI PCI PCI CABG PCI primary PCI staged PCI 679) PCI 2011 676) STEMI 48 63
2012 266,268) CABG 677,680,681) 682,683) 684) CABG 685) STEMI 5 686) 2013 ACCF/AHA 24 CABG 175) STEMI 29,414,687,688) STEMI 689-691) 692) ST 687,693-695) 1mm ST 64
ST 2013 696) 697,698) wall motion score index 698,699) Doppler 700-705) 706-708) 709) STEMI 710-713). 2 714) 715). 716). 717,718) 719) 99m TC 201 Tl 201 Tl 99m Tc 720) 201 Tl SPECT 625,626) 721-726) ATP 723,727) 201 Tl 50 uptake stunned myocardium 123 I-BMIPP 636,728,729) STEMI 123 I-BMIPP 637) MRI 654,662,730) 668,673,731) PET 65
2012 PETSPECT 732,733). STEMI 688,734) 735,736) 737,738) 19,739) 3040 740-743) STEMI BNP 744) STEMI 745,746). BNP probnp N NT-proBNP 747) 1 748) BNP NT-proBNP 34 BNP 5 746) CRPC H-FABP 749-753) STEMI 754) STEMI STEMI implantable cardioverter defibrillatoricd 755,756) 757) 66
ST 2013 ICD 741-743) 758) 759-761) QRS 762,763) T 764) ICD 765-767) PCI STEMI 768,769) GRACE 152,153) TIMI 155) CADILLAC 157) STEMI 20 770-772) 3 I phase I II phase II III phase III 3 STEMI 182006 4 150 QOL 771-775) Taylor 8940 48 3 15 32 20 p 0.005 26 p 0002 774) 1995 Lawler 34 26 39 36 46 775) Haykowsky 647 12 776) ACC/AHA 2004 369) 2007 777) STEMI AHA/ACCF 2011 778) 67
2012 STEMI QOL 779-785) 3 49 785) 19961998 STEMI 512 786) 2004 787) 2009 788) 9 21 PCI 770,772,780,789) 790,791) 2001 AHA 789) 2 STEMI 1224 23 23 ST T ST 9 68
ST 2013 12 792) 1224 369) Valsalva 369) STEMI 793) 14 794) 6 780,789) STEMI 69
2012 369) 2 STEMI 1 13 STEMI 787) 780,789) STEMI 70
ST 2013 369,795) STEMI 795) 3 796) ACC/AHA 795) 4 14 48 14 797) 56 12 7075 Borg 620 15 780,789) 1 24 3 780,789,795) 798) STEMI 799) QOL 800) 801) ACC/AHA 2007 777) STEMI 2011 778) 71
2012 STEMI 23 780) PCI PCI 612 PCI 802,803) 30 5 369) 369,789,794) STEMI ACC/AHA 2004 369) 34 2007 777) 7 5 2008 805) 5METs 3METs3.06.0METs 6.1METs 3.06.0METs 6.1METs 3METs 6.1METs 805) 1 369) 72
ST 2013 12 2 369) AED 806) 710 369) 5 5METs 807) 15 771) 807) 2008 805) Q 808-810) PCI 369) 811) PAMI-II 70 45 1 2 PCI 2 812) STEMI 1520 813) QOL 369) STEMI 814) 369) SSRI 815,816) 1 STEMI STEMI 27 3 782) social isolation 817) 818) 819) 820) STEMI 821) 822) QOL 818) 73
2012 192007 5 823) 824-826) 10 827) 74
ST 2013 75
2012 *repetition maximum10 RM 10 20. QOL 771-775) AHA/ACCF 2011 778) VII. 67 76
ST 2013 2009 828) primary PCI 80 29,220,396) 81162 mg/ 176,302) DES PCI DAPT 829-831) ACC/AHA/SCAI 832) FDA 833) DES 12 j-cypher 6 6 2 309) 1 5 310) 4 13 13 834) 1 DAPT 830,831) DES PPI CYP2C19 313,317,835) PPI CYP2C19 836) 77
2012 78
ST 2013 837) 838-840) PCI 2011 675) 2011 676) 79
2012 ACC AHA 841-843) ACC/AHA quality improvement : QI 842,844,845) 843) ACC/AHA STEMI 843) 1 ACC/ AHA 369,846) primary PCI STEMI 847-849) ACCF/ AHA/SCAI PCI 400 PCI primary PCI 36 75 PCI primary PCI 11 STEMI 308) CVIT 850) PCI J-PCI /National Clinical Database 851) 80
ST 2013 CCU CCU 6 58) 14 60,61) 181) 53 10 78 30 852) 70 1.3 8.7 853) STEMI AHA emergency cardiovascular care ECC CCU PCI STEMI 81
2012 ILCOR CoSTR 2005 AHA 2005 12 PCI 854) 855-857) 3 STEMI CPR AED PADpublic access defibrillation 3 CCU PCI 2007 ACC/AHA 2008 ESC door-to-balloondtb 90 DTB Get With The Guidelines GWTG 2000 ACC/AHA 858,859) STEMI Community Education 119 82
83 ST 2013
84 2012
85 ST 2013
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