Iglesias J F, Roguelov C, Kabir T, Vogt P, Eeckhout E
Service de cardiologie, CHUV, 1011 Lausanne.
Rev Med Suisse. 2009 May 27;5(205):1195-6, 1198-201.
The indications for urgent coronary angiography are stated in the guidelines for treatment of acute coronary syndromes. An invasive approach is considered the treatment of choice for patients presenting with ST elevation myocardial infarction within 12 hours of the beginning of symptoms. In the absence of contraindication, intravenous thrombolysis continues to be a valuable alternative to primary angioplasty within 3 hours of the beginning of clinical symptoms. Urgent coronary angiography continues to be recommended following the failure of thrombolysis, persistent myocardial ischemia after 12 hours of symptoms, recurrent myocardial ischemia following myocardial infarction or in the case of cardiogenic shock.
急性冠状动脉综合征治疗指南中阐述了紧急冠状动脉造影的适应证。对于症状出现12小时内的ST段抬高型心肌梗死患者，侵入性治疗方法被视为首选治疗。在无禁忌证的情况下，静脉溶栓在临床症状出现3小时内仍是直接血管成形术的重要替代方法。溶栓失败、症状出现12小时后仍存在持续性心肌缺血、心肌梗死后反复出现心肌缺血或发生心源性休克时，仍建议进行紧急冠状动脉造影。
