Kurz Kerstin, Katus Hugo A, Giannitsis Evangelos
Abteilung Innere Medizin III, Medizinische Klinik, Universitätsklinikum, Heidelberg.
Herz. 2004 Sep;29(6):575-81. doi: 10.1007/s00059-004-2600-6.
Clinically, coronary artery disease (CAD) presents either as stable angina pectoris or as an acute coronary syndrome. Atypical chest pain or silent myocardial ischemia is not uncommon and may obscure the diagnosis of CAD. Whereas primary or secondary prevention is indicated in all cases with suspected or documented atherosclerosis, cardiac catheterization and revascularization therapy is restricted to patients with significant CAD. In order to detect hemodynamically significant coronary artery stenoses, exercise stress tests or noninvasive stress imaging are usually implemented in the diagnostic workup. By contrast, patients presenting with an acute coronary syndrome require an initial risk stratification for estimation of the acute thrombotic risk associated with the underlying vulnerable plaque. Consecutively, patients without high-risk features need a thorough noninvasive evaluation for the presence of significant CAD which is comparable to patients presenting with chronic stable angina pectoris.
临床上，冠状动脉疾病（CAD）表现为稳定型心绞痛或急性冠状动脉综合征。非典型胸痛或无症状心肌缺血并不少见，可能会掩盖CAD的诊断。虽然在所有疑似或确诊动脉粥样硬化的病例中都需要进行一级或二级预防，但心脏导管插入术和血运重建治疗仅限于患有严重CAD的患者。为了检测具有血流动力学意义的冠状动脉狭窄，通常在诊断检查中进行运动负荷试验或无创负荷成像。相比之下，患有急性冠状动脉综合征的患者需要进行初始风险分层，以评估与潜在易损斑块相关的急性血栓形成风险。接下来，没有高危特征的患者需要对是否存在严重CAD进行全面的无创评估，这与患有慢性稳定型心绞痛的患者类似。
