急性冠脉综合征指南课件`.ppt

11/02 The Management of Patients with Unstable Angina andNon-ST-Segment ElevationMyocardial Infarction ACC/AHA Pocket Guidelines November, 2002 ACC/AHA Classifications Expert Opinion and Recommendations Class I Conditions for which there is evidence and/or general agreement that a given procedure or treatment is beneficial, useful, and effective Class II Conditions for which there is conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of a procedure or treatment Class IIa weight of evidence/opinion is in favor of usefulness/efficacy Class IIb usefulness/efficacy is less well established by evidence/opinion Class III Conditions for which there is evidence and/or general agreement that the procedure/treatment is not useful/effective and in some cases may be harmful II. Initial Evaluationand Management A. Clinical Assessment B. Early Risk Stratification C. Immediate Management A. Clinical Assessment Recommendation for Initial Triage Class I 1. Patient with possible ACS should not be evaluated solely over the telephone but should be referred to a facility that allows evaluation by a physician and the recording of a 12-lead electrocardiogram (ECG) 2. Patients with a suspected ACS with chest discomfort at rest for 20 minutes, hemodynamic instability, or recent syncope or presyncope should be strongly considered for immediate referral to an emergency department or a specialized chest pain unit B. Early Risk Stratification Recommendation Class I 1. Patients who present with chest discomfort should undergo early risk stratification that focuses on anginal symptoms, physical findings, ECG findings, and biomarkers of cardiac injury 2. A 12-lead ECG should be obtained immediately in patients with ongoing chest discomfort B. Early Risk Stratification Recommendation Class I 3. Biomarkers of cardiac injury should be measured in all patients who present with chest discomfort consistent with ACS. A cardiac -specific troponin is th