Pollack C V, Gibler W B
Pennsylvania Hospital, Philadelphia, PA 19107, USA.
Ann Emerg Med. 2001 Sep;38(3):229-40. doi: 10.1067/mem.2001.117955.
There have been numerous significant clinical advances in both the diagnosis and therapy of acute coronary syndrome during the past several years. Even the term "acute coronary syndrome" is a recent creation meant to expand clinical attention in patients with chest pain of coronary origin beyond identification of ST-segment elevation myocardial infarction and prompt initiation of reperfusion therapy and to include the evaluation and management of those patients with unstable angina (UA) or myocardial injury that does not cause ST-segment elevation. Many of these advances have been studied and first implemented outside the emergency department, leading some emergency physicians to be slow to embrace them, and leaving others without a viable practical option to use them outside of the cardiac catheterization laboratory or the coronary care unit. In September 2000, the American College of Cardiology and the American Heart Association issued practice guidelines for the care of patients with UA and non-ST-segment elevation myocardial infarction. The guidelines specifically address the diagnosis and management of UA and non-ST-segment elevation myocardial infarction in the ED, suggesting evidence-based standards for risk stratification, for the use of biologic markers of myocardial damage and other adjunctive diagnostic tests, and for the appropriate use of antiplatelet and antithrombin therapeutic agents. This article provides an overview of the ED-pertinent analyses and recommendations from the 93-page document. A commentary on the implementation of these recommendations in the ED follows in a separate article.
在过去几年中，急性冠状动脉综合征的诊断和治疗都取得了许多重大的临床进展。甚至“急性冠状动脉综合征”这个术语也是最近才出现的，其目的是将临床对冠状动脉源性胸痛患者的关注范围扩大，不仅仅局限于识别ST段抬高型心肌梗死并迅速启动再灌注治疗，还包括对不稳定型心绞痛（UA）或无ST段抬高的心肌损伤患者的评估和管理。其中许多进展是在急诊科之外进行研究并首次应用的，这导致一些急诊医生接受这些进展的速度较慢，而另一些医生在心脏导管实验室或冠心病监护病房之外没有可行的实际方法来应用它们。2000年9月，美国心脏病学会和美国心脏协会发布了UA和非ST段抬高型心肌梗死患者治疗的实践指南。该指南特别针对急诊科中UA和非ST段抬高型心肌梗死的诊断和管理，提出了基于证据的风险分层标准、心肌损伤生物标志物及其他辅助诊断检查的使用标准，以及抗血小板和抗凝血酶治疗药物的合理使用标准。本文概述了这份93页文件中与急诊科相关的分析和建议。另一篇单独的文章将对这些建议在急诊科的实施情况进行评论。
