急性冠脉综合征指南ppt课件

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1、TheManagementofPatientswithUnstableAnginaandNon-ST-SegmentElevationMyocardialInfarctionACC/AHAPocketGuidelinesNovember,200211/021medslides.comACC/AHAClassificationsExpertOpinionandRecommendationsClassIConditionsforwhichthereisevidenceand/orgeneralagreementthatagivenp

2、rocedureortreatmentisbeneficial,useful,andeffectiveClassIIConditionsforwhichthereisconflictingevidenceand/oradivergenceofopinionabouttheusefulness/efficacyofaprocedureortreatmentClassIIaweightofevidence/opinionisinfavorofusefulness/efficacyClassIIbusefulness/efficacyisl

3、esswellestablishedbyevidence/opinionClassIIIConditionsforwhichthereisevidenceand/orgeneralagreementthattheprocedure/treatmentisnotuseful/effectiveandinsomecasesmaybeharmful11/022medslides.comII.InitialEvaluationandManagementA.ClinicalAssessmentB.EarlyRiskStratification

4、C.ImmediateManagement11/023medslides.comA.ClinicalAssessmentRecommendationforInitialTriageClassI1.PatientwithpossibleACSshouldnotbeevaluatedsolelyoverthetelephonebutshouldbereferredtoafacilitythatallowsevaluationbyaphysicianandtherecordingofa12-leadelectrocardiogram(EC

5、G)2.PatientswithasuspectedACSwithchestdiscomfortatrestfor>20minutes,hemodynamicinstability,orrecentsyncopeorpresyncopeshouldbestronglyconsideredforimmediatereferraltoanemergencydepartmentoraspecializedchestpainunit11/024medslides.comB.EarlyRiskStratificationRecommendati

6、onClassI1.Patientswhopresentwithchestdiscomfortshouldundergoearlyriskstratificationthatfocusesonanginalsymptoms,physicalfindings,ECGfindings,andbiomarkersofcardiacinjury2.A12-leadECGshouldbeobtainedimmediatelyinpatientswithongoingchestdiscomfort11/025medslides.comB.Earl

7、yRiskStratificationRecommendationClassI3.BiomarkersofcardiacinjuryshouldbemeasuredinallpatientswhopresentwithchestdiscomfortconsistentwithACS.Acardiac-specifictroponinisthepreferredmarker,andifavailable,itshouldbemeasuredinallpatients.Creatinephosphokinase-MBisoenzyme(C

8、K-MB)bymassassayisalsoacceptable.Inpatientswithnegativecardiacmarkerswithin6hoursoftheonsetofpain,anothersampl