Switaj Timothy L, Christensen Scott R, Brewer Dean M
U.S. Army Medical Department Center and School, Fort Sam Houston, TX, USA.
Martin Army Community Hospital Family Medicine Residency Program, Fort Benning, GA, USA.
Am Fam Physician. 2017 Feb 15;95(4):232-240.
Acute coronary syndrome continues to be a significant cause of morbidity and mortality in the United States. Family physicians need to identify and mitigate risk factors early, as well as recognize and respond to acute coronary syndrome events quickly in any clinical setting. Diagnosis can be made based on patient history, symptoms, electrocardiography findings, and cardiac biomarkers, which delineate between ST elevation myocardial infarction and non-ST elevation acute coronary syndrome. Rapid reperfusion with primary percutaneous coronary intervention is the goal with either clinical presentation. Coupled with appropriate medical management, percutaneous coronary intervention can improve short- and long-term outcomes following myocardial infarction. If percutaneous coronary intervention cannot be performed rapidly, patients with ST elevation myocardial infarction can be treated with fibrinolytic therapy. Fibrinolysis is not recommended in patients with non-ST elevation acute coronary syndrome; therefore, these patients should be treated with medical management if they are at low risk of coronary events or if percutaneous coronary intervention cannot be performed. Post-myocardial infarction care should be closely coordinated with the patient's cardiologist and based on a comprehensive secondary prevention strategy to prevent recurrence, morbidity, and mortality.
在美国，急性冠状动脉综合征仍然是发病和死亡的重要原因。家庭医生需要尽早识别并减轻危险因素，同时在任何临床环境中都能迅速识别并应对急性冠状动脉综合征事件。诊断可基于患者病史、症状、心电图检查结果和心脏生物标志物，这些有助于区分ST段抬高型心肌梗死和非ST段抬高型急性冠状动脉综合征。无论是哪种临床表现，主要目标都是通过直接经皮冠状动脉介入治疗实现快速再灌注。结合适当的药物治疗，经皮冠状动脉介入治疗可改善心肌梗死后的短期和长期预后。如果不能迅速进行经皮冠状动脉介入治疗，ST段抬高型心肌梗死患者可接受纤维蛋白溶解疗法治疗。非ST段抬高型急性冠状动脉综合征患者不建议使用纤维蛋白溶解疗法；因此，如果这些患者发生冠状动脉事件的风险较低或无法进行经皮冠状动脉介入治疗，应采用药物治疗。心肌梗死后的护理应与患者的心脏病专家密切协调，并基于全面的二级预防策略，以防止复发、发病和死亡。
