急性冠脉综合征指南课件.ppt

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

2、cedureortreatmentisbeneficial,useful,andeffectiveClassIIConditionsforwhichthereisconflictingevidenceand/oradivergenceofopinionabouttheusefulness/efficacyofaprocedureortreatmentClassIIaweightofevidence/opinionisinfavorofusefulness/efficacyClassIIbusefulness/efficacyislessw

3、ellestablishedbyevidence/opinionClassIIIConditionsforwhichthereisevidenceand/orgeneralagreementthattheprocedure/treatmentisnotuseful/effectiveandinsomecasesmaybeharmful11/022medslides.comII.InitialEvaluationandManagementA.ClinicalAssessmentB.EarlyRiskStratificationC.Imm

4、ediateManagement11/023medslides.comA.ClinicalAssessmentRecommendationforInitialTriageClassI1.PatientwithpossibleACSshouldnotbeevaluatedsolelyoverthetelephonebutshouldbereferredtoafacilitythatallowsevaluationbyaphysicianandtherecordingofa12-leadelectrocardiogram(ECG)2.Pati

5、entswithasuspectedACSwithchestdiscomfortatrestfor>20minutes,hemodynamicinstability,orrecentsyncopeorpresyncopeshouldbestronglyconsideredforimmediatereferraltoanemergencydepartmentoraspecializedchestpainunit11/024medslides.comB.EarlyRiskStratificationRecommendationClassI1.

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

7、icationRecommendationClassI3.BiomarkersofcardiacinjuryshouldbemeasuredinallpatientswhopresentwithchestdiscomfortconsistentwithACS.Acardiac-specifictroponinisthepreferredmarker,andifavailable,itshouldbemeasuredinallpatients.Creatinephosphokinase-MBisoenzyme(CK-MB)bymassass

8、ayisalsoacceptable.Inpatientswithnegativecardiacmarkerswithin6hoursoftheonsetofpain,anothersampl