Johns Hopkins School of Medicine, Baltimore, MD, USA.
Crit Care Med. 2011 Oct;39(10):2346-53. doi: 10.1097/CCM.0b013e31821e855f.
Acute coronary syndrome is a common cause of morbidity and mortality, both in the United States and worldwide. The goal of this review is to familiarize clinicians with recent information regarding the diagnosis and treatment of acute coronary syndrome.
PubMed search and review of the relevant medical literature.
Acute coronary syndrome encompasses three clinical diagnoses: unstable angina, non-ST-segment elevation myocardial infarction), and ST-segment elevation myocardial infarction. The definition, pathophysiology, clinical presentation, diagnosis, and treatment of unstable angina/non-ST-segment elevation myocardial infarction are reviewed here. Diagnosing unstable angina/non-ST-segment elevation myocardial infarction is a significant challenge in critically ill patients not initially suspected of having acute coronary syndrome (i.e., noncardiac intensive care unit patients), and diagnostic and treatment strategies for these patients have not been clearly established.
Patients with acute coronary syndrome benefit from intensive medical therapy, including antianginal, antiplatelet, antithrombotic, and statin agents. Depending on their risk for future cardiovascular events as well as their risk of bleeding complications, patients may benefit from either an early invasive treatment strategy, in which routine coronary revascularization is performed, or a conservative strategy, in which revascularization is reserved for patients with recurrent or provocable cardiac ischemia.
急性冠状动脉综合征是美国和全球范围内发病率和死亡率的常见原因。本综述的目的是使临床医生熟悉有关急性冠状动脉综合征的诊断和治疗的最新信息。
PubMed 搜索和相关医学文献复习。
急性冠状动脉综合征包括三种临床诊断：不稳定型心绞痛、非 ST 段抬高型心肌梗死和 ST 段抬高型心肌梗死。本文回顾了不稳定型心绞痛/非 ST 段抬高型心肌梗死的定义、病理生理学、临床表现、诊断和治疗。在最初怀疑没有急性冠状动脉综合征的危重症患者（即非心脏重症监护病房患者）中，诊断不稳定型心绞痛/非 ST 段抬高型心肌梗死是一项重大挑战，并且尚未明确这些患者的诊断和治疗策略。
急性冠状动脉综合征患者受益于强化药物治疗，包括抗心绞痛、抗血小板、抗血栓和他汀类药物。根据未来心血管事件的风险以及出血并发症的风险，患者可能受益于早期侵入性治疗策略，其中常规进行冠状动脉血运重建，或者保守治疗策略，其中仅对出现复发性或可诱发性心肌缺血的患者进行血运重建。
