Deckers Jaap W, Zijlstra Felix
Erasmus MC, Thoraxcentrum, afd. Cardiologie, Rotterdam.
Ned Tijdschr Geneeskd. 2016;160:A9599.
The diagnosis acute coronary syndrome includes myocardial infarction together with unstable angina. The definition of the latter diagnosis continues to evolve. Due to widespread clinical application of sensitive markers of myocardial necrosis, including high sensitive cardiac troponin (hs-cTn) assays, the diagnosis for many newly presenting patients will now be myocardial infarction rather than unstable angina. However, patients presenting with chest pain and very low (< 0.05 ng/L) or undetectable levels of hs-cTn have been found to be at extremely low risk of development of myocardial infarction and/or death. Consequently, such patients cannot be classified as having unstable angina. A detailed clinical assessment and reasoning will be necessary to establish the true cause of their--often non-cardiac--symptoms.
急性冠状动脉综合征的诊断包括心肌梗死和不稳定型心绞痛。后者诊断的定义仍在不断演变。由于心肌坏死敏感标志物（包括高敏心肌肌钙蛋白（hs-cTn）检测）在临床中的广泛应用，现在许多新发病例的诊断将是心肌梗死而非不稳定型心绞痛。然而，已发现出现胸痛且hs-cTn水平极低（<0.05 ng/L）或检测不到的患者发生心肌梗死和/或死亡的风险极低。因此，这类患者不能归类为不稳定型心绞痛。需要进行详细的临床评估和推理，以确定其（通常为非心脏性）症状的真正原因。
