Barstow Craig
Womack Army Medical Center, 2817 Reilly Road, Fort Bragg, NC 28310-73010.
FP Essent. 2020 Mar;490:11-19.
Acute coronary syndrome (ACS) is an acute myocardial infarction (MI) or ischemia, usually from acutely disrupted coronary artery blood flow. Patients commonly present to the emergency department (ED) with chest pain or pressure but sometimes have atypical symptoms. Evaluation begins with an electrocardiogram (ECG) obtained within 10 minutes of presentation. If ST-segment elevation is present, ST-segment elevation MI (STEMI) is diagnosed. If STEMI is not present, troponin levels should be measured using one of several recommended protocols. Troponin levels greater than 99th percentile of the upper reference limit are consistent with ACS. If the ECG finding is normal and results of two troponin tests are negative, risk stratification should be calculated using Thrombosis in Myocardial Infarction (TIMI) or HEART (History, ECG, Age, Risk factors, initial Troponin) score. Based on the score, further evaluation to exclude coronary artery disease (CAD) is completed during hospitalization or after discharge, using exercise treadmill testing, stress echocardiography, myocardial perfusion scintigraphy, or coronary computed tomography angiography. Although ACS is less likely in outpatients, CAD must still be considered. Many patients with ACS are misdiagnosed. Between 2% and 5% of patients are inappropriately discharged from the ED.
急性冠状动脉综合征（ACS）是一种急性心肌梗死（MI）或缺血，通常由冠状动脉血流急性中断引起。患者通常因胸痛或胸部压迫感而前往急诊科（ED）就诊，但有时会出现非典型症状。评估从就诊后10分钟内进行的心电图（ECG）检查开始。如果出现ST段抬高，则诊断为ST段抬高型心肌梗死（STEMI）。如果不存在STEMI，则应使用几种推荐方案之一测量肌钙蛋白水平。肌钙蛋白水平高于参考上限第99百分位数与ACS相符。如果心电图检查结果正常且两次肌钙蛋白检测结果均为阴性，则应使用心肌梗死溶栓（TIMI）或HEART（病史、心电图、年龄、危险因素、初始肌钙蛋白）评分进行风险分层计算。根据该评分，在住院期间或出院后，使用运动平板试验、负荷超声心动图、心肌灌注闪烁扫描或冠状动脉计算机断层扫描血管造影进一步评估以排除冠状动脉疾病（CAD）。虽然门诊患者发生ACS的可能性较小，但仍必须考虑CAD。许多ACS患者被误诊。2%至5%的患者被不恰当地从急诊科出院。
