Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
Am J Cardiol. 2011 Feb 15;107(4):509-15. doi: 10.1016/j.amjcard.2010.10.016. Epub 2010 Dec 22.
The presentation of patients with suspected non ST-elevation acute coronary syndromes is quite diverse. Therefore, the diagnostic workup and choice of treatment may vary accordingly. Major issues regarding the evaluation are the likelihood of the diagnosis and the risk for adverse events. These factors should guide the choice of diagnostic test. Patients with increased risk for ischemic events and patients with recurrent ischemia are most likely to benefit from revascularization. In addition, when percutaneous coronary intervention is considered, evidence suggests that sufficient time should be allowed for pharmacologic stabilization, reducing the possibility of periprocedurally inflicted myocardial infarction. However, postponement of intervention may lead to an increase of new spontaneous events, and high-risk patients should apply for revascularization soon after pharmacologic stabilization. The extent of revascularization performed by percutaneous coronary intervention depends predominantly on patient characteristics and anatomy but should be limited to flow-obstructive lesions. In conclusion, patients presenting with non-ST elevation acute coronary syndromes constitute a very diverse population; diagnostic workup, treatment, and the timing of a possible intervention should be tailored individually.
疑似非 ST 段抬高型急性冠脉综合征患者的临床表现多种多样。因此，诊断方法的选择和治疗方案可能会有所不同。评估的主要问题是诊断的可能性和不良事件的风险。这些因素应指导诊断性检查的选择。有缺血性事件风险增加的患者和有复发性缺血的患者最有可能从血运重建中获益。此外，当考虑经皮冠状动脉介入治疗时，有证据表明，应给予足够的时间进行药物稳定，以降低经皮冠状动脉介入治疗过程中造成心肌梗死的可能性。然而，延迟介入可能会导致新的自发性事件增加，高危患者应在药物稳定后尽快进行血运重建。经皮冠状动脉介入治疗的血运重建范围主要取决于患者的特征和解剖结构，但应仅限于血流阻塞性病变。总之，表现为非 ST 段抬高型急性冠脉综合征的患者构成了一个非常多样化的人群；诊断方法、治疗和可能的干预时机应个体化制定。
