Antman E M, Fox K M
Samuel L. Levine Cardiac Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA 02115, USA.
Am Heart J. 2000 Mar;139(3):461-75. doi: 10.1016/s0002-8703(00)90090-5.
In 1994, the United States Agency for Health Care Policy and Research issued clinical practice guidelines for the diagnosis and management of unstable angina and non-Q-wave myocardial infarction. In the past 5 years, rapid progress has been made in the management of patients with unstable coronary syndromes, yet current guidelines do not necessarily reflect these advances.
An international forum of cardiology investigators reviewed existing guidelines and discussed areas in which the diagnosis and treatment of unstable angina and non-Q-wave myocardial infarction should be modified. It was agreed that there is sufficient evidence to recommend the following changes: (1) use of serum cardiac markers should be expanded to include troponin I and T levels as diagnostic and prognostic tools; (2) low-molecular-weight heparins should replace unfractionated heparin as antithrombotic agents; (3) new classes of antiplatelet agents are recommended in addition to aspirin; and (4) the use of cholesterol-lowering drugs is appropriate in the long-term management of these patients.
Evidence from clinical trials within the last 5 years requires that significant changes be made to existing guidelines for the diagnosis and management of unstable angina and non-Q-wave myocardial infarction. The recommendations detailed should be considered in the creation and implementation of updated guidelines.
1994年，美国医疗保健政策与研究机构发布了不稳定型心绞痛和非Q波心肌梗死诊断与管理的临床实践指南。在过去5年中，不稳定型冠状动脉综合征患者的管理取得了快速进展，但当前指南不一定能反映这些进展。
一个国际心脏病学研究人员论坛审查了现有指南，并讨论了不稳定型心绞痛和非Q波心肌梗死的诊断与治疗应修改的领域。大家一致认为，有充分证据推荐以下改变：（1）血清心脏标志物的使用应扩大到包括肌钙蛋白I和T水平作为诊断和预后工具；（2）低分子量肝素应取代普通肝素作为抗血栓药物；（3）除阿司匹林外，推荐使用新型抗血小板药物；（4）在这些患者的长期管理中使用降胆固醇药物是合适的。
过去5年临床试验的证据要求对不稳定型心绞痛和非Q波心肌梗死的现有诊断与管理指南进行重大修改。在制定和实施更新指南时应考虑详细的建议。
