Jobs A, Thiele H
Medizinische Klinik II (Kardiologie/Angiologie/Intensivmedizin), Universitäres Herzzentrum Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
Herz. 2015 Dec;40(8):1027-33. doi: 10.1007/s00059-015-4369-1.
In August 2015 the European Society of Cardiology (ESC) published new guidelines for the management of acute coronary syndrome in patients presenting without persistent ST-segment elevation, which incorporate the scientific progress since 2011. The innovation with probably the most impact on the clinical practice is the introduction of 0 h/1 h protocols for exclusion or inclusion of myocardial infarction without ST-segment elevation. These 0 h/1 h protocols are equally recommended to the established 0 h/3 h protocol. For these protocols blood is drawn on admission and 1 h later and the troponin level is analyzed by means of highly sensitive troponin assays. Troponin cut-off values were validated in several large studies, therefore, now facilitating a faster exclusion of myocardial infarction with an equal negative predictive value to 3 h protocols. Additionally, access via the radial artery is recommended over a femoral artery access for coronary angiography and when necessary the subsequent coronary intervention. Other novel aspects apply to the anti-ischemic and anti-thrombotic medication.
2015年8月，欧洲心脏病学会（ESC）发布了无持续性ST段抬高患者急性冠状动脉综合征管理的新指南，其中纳入了自2011年以来的科学进展。对临床实践影响可能最大的创新是引入了用于排除或纳入无ST段抬高心肌梗死的0小时/1小时方案。这些0小时/1小时方案与既定的0小时/3小时方案同样被推荐。对于这些方案，入院时和1小时后采血，并通过高敏肌钙蛋白检测法分析肌钙蛋白水平。肌钙蛋白临界值在多项大型研究中得到验证，因此，现在能够更快地排除心肌梗死，其阴性预测值与3小时方案相当。此外，对于冠状动脉造影以及必要时的后续冠状动脉介入治疗，推荐经桡动脉途径而非股动脉途径。其他新的方面适用于抗缺血和抗血栓药物。
