1、Diagnosis and Mechanism of Increased Coronary Risk soon after Acute Coronary Syndromes2021/4/261Persistent InstabilityDuke database2021/4/262Recent Trials in Acute Coronary SyndromesTrialAdditionaltherapyEnd-point 4-6 month MIRACLEhigh dose Atorvastatindeath, AMI, unstable angina, cardiac arrest14.8

2、%TACTICS TIMI 18Tirofiban + revascularizationearly death, AMI,new readmission16%2021/4/263AgeLeft ventricular functionEffort toleranceClinical Post-discharge Classification of Patients with ACSMaseri, Ischemic Heart Disease, 19952021/4/264Predictive value of MPO for incidence of death and nonfatal m

3、yocardial infarctionBaldus S et al, Circulation 20032021/4/265300112241636437411313102040608010012014019909192939495969798992000010203C-Reactive Protein and CAD2021/4/266TYPE 1Infarction out of the blue preceded and followed by complete stabilityTYPE 2Unstable angina followed by infarction followed

4、by recurrent ACS Maseri A, Italian Heart J 2003Spectrum of Clinical Phenotypes2021/4/267Biological PhenotypesBiasucci LM et al, Circulation 1999Bogarty P et al, Circulation 2001Persisting CRP elevation post-discharge predics recurrent instability2021/4/268CRP Levels 3 mg/l 0102030405060708090100admi

5、ssiondischarge3 months1 yearPatients (%)Biasucci LM, Circulation 19992021/4/269Biasucci LM, Circulation 1999CRP3 mg/LCRP3 mg/LCRP3 mg/L%Cum. SurvivalP0.001Event free survival according to CRP levels at discharge in UAMonths2021/4/26109、 人的價值，在招收誘惑的一瞬間被決定。2022/7/142022/7/14Thursday, July 14, 202210、低

6、頭要有勇氣，抬頭要有低氣。2022/7/142022/7/142022/7/147/14/2022 9:22:54 PM11、人總是珍惜為得到。2022/7/142022/7/142022/7/14Jul-2214-Jul-2212、人亂于心，不寬余請。2022/7/142022/7/142022/7/14Thursday, July 14, 202213、生氣是拿別人做錯的事來懲罰自己。2022/7/142022/7/142022/7/142022/7/147/14/202214、抱最大的希望，作最大的努力。14 七月 20222022/7/142022/7/142022/7/1415、一個

7、人炫耀什么，說明他內心缺少什么。七月 222022/7/142022/7/142022/7/147/14/202216、業余生活要有意義，不要越軌。2022/7/142022/7/1414 July 202217、一個人即使已登上頂峰，也仍要自強不息。2022/7/142022/7/142022/7/142022/7/14Multiple unstable lesions Goldstein et al. NEJM 2000 Zairis M et al. Atherosclerosis 2000Widespread inflammation in ACSWidespread coronary

8、 inflammation Buffon A et al. NEJM 20022021/4/26129、 人的價值，在招收誘惑的一瞬間被決定。2022/7/142022/7/14Thursday, July 14, 202210、低頭要有勇氣，抬頭要有低氣。2022/7/142022/7/142022/7/147/14/2022 9:22:54 PM11、人總是珍惜為得到。2022/7/142022/7/142022/7/14Jul-2214-Jul-2212、人亂于心，不寬余請。2022/7/142022/7/142022/7/14Thursday, July 14, 202213、生氣是拿

9、別人做錯的事來懲罰自己。2022/7/142022/7/142022/7/142022/7/147/14/202214、抱最大的希望，作最大的努力。14 七月 20222022/7/142022/7/142022/7/1415、一個人炫耀什么，說明他內心缺少什么。七月 222022/7/142022/7/142022/7/147/14/202216、業余生活要有意義，不要越軌。2022/7/142022/7/1414 July 202217、一個人即使已登上頂峰，也仍要自強不息。2022/7/142022/7/142022/7/142022/7/14Infectious and non inf

10、ectious agents: bacteria, viruses, oxydants, toxinsEnhanced inflammatory responsiveness Maseri NEJM 1997; Liuzzo: Circulation 1998, 2001; JACC 1999 Immunological stimuli Circulation: Liuzzo 1999, 2000, Caligiuri 2000, Biasucci 2003Mechanisms of Inflammation in ACS2021/4/2614ConclusionsThe inflammato

11、ry mechanisms are multiple and not equally important in all patients with ACS.Their precise identification is required for a targetted prevention of inflammationInhibition of key inflammatory final triggers of thrombosis appears an attractive therapeutic target.Patients with recurrent instability an

12、d elevated inflammatory markers are ideal candidates for pilot studies 2021/4/26159、 人的價值，在招收誘惑的一瞬間被決定。14-7月-2214-7月-22Thursday, July 14, 202210、低頭要有勇氣，抬頭要有低氣。*7/14/2022 9:22:54 PM11、人總是珍惜為得到。14-7月-22*Jul-2214-Jul-2212、人亂于心，不寬余請。*Thursday, July 14, 202213、生氣是拿別人做錯的事來懲罰自己。14-7月-2214-7月-22*14 July 202

13、214、抱最大的希望，作最大的努力。14 七月 2022*14-7月-2215、一個人炫耀什么，說明他內心缺少什么。七月 22*14-7月-22*14 July 202216、業余生活要有意義，不要越軌。*7/14/202217、一個人即使已登上頂峰，也仍要自強不息。*14-7月-22謝謝大家2021/4/26169、 人的價值，在招收誘惑的一瞬間被決定。2022/7/142022/7/14Thursday, July 14, 202210、低頭要有勇氣，抬頭要有低氣。2022/7/142022/7/142022/7/147/14/2022 9:22:54 PM11、人總是珍惜為得到。2022/7/142022/7/142022/7/14Jul-2214-Jul-2212、人亂于心，不寬余請。2022/7/142022/7/142022/7/14Thursday, July 14, 202213、生氣是拿別人做錯的事來懲罰自己。2022/7/142022/7/142022/7/142022/7/147/14/202214、抱最大的希望，作最大的努力。14 七