急性冠脉综合征指南-PPT课件.ppt

TheManagementofPatientswithUnstableAnginaand

Non-ST-SegmentElevation

MyocardialInfarctionACC/AHAPocketGuidelinesNovember,200211/021

ACC/AHAClassifications

ExpertOpinionandRecommendationsClassIConditionsforwhichthereisevidenceand/orgeneralagreementthatagivenprocedureortreatmentisbeneficial,useful,andeffectiveClassIIConditionsforwhichthereisconflictingevidenceand/oradivergenceofopinionabouttheusefulness/efficacyofaprocedureortreatmentClassIIaweightofevidence/opinionisinfavorofusefulness/efficacyClassIIbusefulness/efficacyislesswellestablishedbyevidence/opinionClassIIIConditionsforwhichthereisevidenceand/orgeneralagreementthattheprocedure/treatmentisnotuseful/effectiveandinsomecasesmaybeharmful11/022

II.InitialEvaluation

andManagement A.ClinicalAssessment B.EarlyRiskStratification

C.ImmediateManagement11/023

A.ClinicalAssessment

RecommendationforInitialTriageClassI 1.PatientwithpossibleACSshouldnotbeevaluatedsolelyoverthetelephonebutshouldbereferredtoafacilitythatallowsevaluationbyaphysicianandtherecordingofa12-leadelectrocardiogram(ECG) 2.PatientswithasuspectedACSwithchestdiscomfortatrestfor20minutes,hemodynamicinstability,orrecentsyncopeorpresyncopeshouldbestronglyconsideredforimmediatereferraltoanemergencydepartmentoraspecializedchestpainunit11/024

B.EarlyRiskStratification

RecommendationClassI 1.Patientswhopresentwithchestdiscomfortshouldundergoearlyriskstratificationthatfocusesonanginalsymptoms,physicalfindings,ECGfindings,andbiomarkersofcardiacinjury 2.A12-leadECGshouldbeobtainedimmediatelyinpatientswithongoingchestdiscomfort11/025

B.EarlyRiskStratification

RecommendationClassI 3.BiomarkersofcardiacinjuryshouldbemeasuredinallpatientswhopresentwithchestdiscomfortconsistentwithACS.Acardiac-specifictroponin