TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts 02115, USA.
Am J Respir Crit Care Med. 2012 May 1;185(9):924-32. doi: 10.1164/rccm.201109-1745CI. Epub 2011 Dec 28.
Non-ST elevation acute coronary syndromes are responsible for approximately 1 million admissions to U.S. hospitals and twice as many to European hospitals each year. Thus, they are among the most common serious illnesses in adults, and are associated with an in-hospital mortality of approximately 5%. The most common cause is rupture of an atherosclerotic coronary plaque, resulting in subtotal coronary occlusion. Diagnosis is based on the clinical picture of retrosternal chest pain, aided by electrocardiographic findings of ST segment deviations and biomarker abnormalities (elevation of troponin and natriuretic peptides) and cardiac imaging (myocardial scans showing perfusion defects). Treatment involves antiischemic agents (nitrates and β blockers), antiplatelet drugs (aspirin, P2Y(12), and glycoprotein IIb/IIIa receptor blockers), and anticoagulants (unfractionated and low-molecular-weight heparins). Patients should undergo risk stratification, and those with high-risk factors should undergo coronary arteriography promptly with the intent to carry out coronary revascularization. Those at low risk should continue to receive intensive antiischemic and antithrombotic therapy. At discharge, patients should receive intensive lipid-lowering therapy with high doses of a statin, as tolerated.
非 ST 段抬高型急性冠状动脉综合征每年导致约 100 万美国人住院，欧洲则为其两倍。因此，这类疾病是成年人中最常见的严重疾病之一，住院死亡率约为 5%。最常见的病因是动脉粥样硬化斑块破裂，导致冠状动脉不完全阻塞。诊断基于胸骨后胸痛的临床症状，心电图显示 ST 段偏移和生物标志物异常（肌钙蛋白和利钠肽升高）以及心脏成像（心肌扫描显示灌注缺损）有助于诊断。治疗包括抗缺血药物（硝酸酯类和β受体阻滞剂）、抗血小板药物（阿司匹林、P2Y12 和糖蛋白 IIb/IIIa 受体阻滞剂）和抗凝药物（普通肝素和低分子肝素）。患者应进行危险分层，高危患者应尽快进行冠状动脉造影以进行冠状动脉血运重建。低危患者应继续接受强化抗缺血和抗血栓治疗。出院时，患者应根据耐受情况接受大剂量他汀类药物的强化降脂治疗。
