Hamm C W
Kerckhoff Heart Center, Benekestrasse 2-8, D-61231, Bad Nauheim, Germany.
Thromb Res. 2001 Sep 30;103 Suppl 1:S63-9. doi: 10.1016/s0049-3848(01)00299-7.
Acute coronary syndromes (ACSs) represent the acute life-threatening phases of coronary heart disease. Clinical symptoms, EKG, and CK-MB measurements are frequently insufficient to evaluate patients without persisting ST elevations. Serial determinations of troponin T or troponin I after arrival in hospital disclose minor myocardial injury in patients presenting as unstable angina. This finding allows the currently best risk stratification and may contribute to cost-effectiveness. Without elevated troponins the risk for death or myocardial infarction during 30 days follow-up is not more than 1%. The lack of elevated troponins does not implicate that these patients do not have coronary artery disease. Patients with positive evidence of troponins represent a high-risk group who should be hospitalized and further evaluated, because the risk for myocardial infarction and death in 30 days is approximately 20%. Current studies indicate that early revascularization under glycoprotein IIb/IIIa antagonists represent the optimal treatment.
急性冠状动脉综合征（ACSs）是冠心病的急性危及生命阶段。临床症状、心电图和肌酸激酶同工酶（CK-MB）检测常常不足以评估无持续性ST段抬高的患者。患者入院后连续测定肌钙蛋白T或肌钙蛋白I可发现表现为不稳定型心绞痛患者存在轻微心肌损伤。这一发现有助于目前最佳的风险分层，并可能提高成本效益。肌钙蛋白未升高时，30天随访期间死亡或心肌梗死风险不超过1%。肌钙蛋白未升高并不意味着这些患者没有冠状动脉疾病。肌钙蛋白呈阳性的患者属于高危组，应住院并进一步评估，因为30天内心肌梗死和死亡风险约为20%。目前的研究表明，在糖蛋白IIb/IIIa拮抗剂作用下早期血运重建是最佳治疗方法。
