Deedwania P C, Amsterdam E A, Vagelos R H
School of Medicine, University of California, San Francisco, USA.
Arch Intern Med. 1997 Feb 10;157(3):273-80.
Current management of patients after an acute myocardial infarction (AMI) reflects a variety of approaches ranging from conservative to aggressive. Although each method is appropriate in certain subgroups, their application frequently lacks a scientific basis. Current, clinically relevant, evidence-based practice guidelines are needed for secondary prevention for survivors after an AMI. To meet this need, the California Cardiology Working Group was assembled to evaluate the available data from clinical trials and other published studies and develop evidence-based, cost-effective guidelines for clinicians to use as a basis for patient management after an AMI. The group consisted of 18 members, including cardiologists from academic institutions and physicians working in cardiac intensive care, private practices, and managed care settings, representing a broad spectrum of expertise pertaining to patients who have had an AMI. The members had expertise in cardiac intensive care, interventional cardiology, nuclear cardiology, lipid disorders, echocardiography, and cardiac rehabilitation. The intended audience for these practice guidelines includes all physicians who treat survivors of MI. A literature review of all relevant clinical trials and other published data about the natural history after AMI and the effects of current therapeutic modalities are discussed herein. Case histories served as models for application of the literature-based data. The recommendations for management were reached by consensus vote based on the scientific evidence. When more than 1 management option applied, this was recognized in the recommendations. The recommendations accompany the text.
急性心肌梗死（AMI）后患者的当前管理方法多种多样，从保守治疗到积极治疗都有。虽然每种方法在某些亚组中是合适的，但它们的应用往往缺乏科学依据。AMI后幸存者的二级预防需要当前具有临床相关性的循证实践指南。为满足这一需求，成立了加利福尼亚心脏病学工作组，以评估来自临床试验和其他已发表研究的现有数据，并为临床医生制定基于证据、具有成本效益的指南，作为AMI后患者管理的依据。该小组由18名成员组成，包括来自学术机构的心脏病专家以及在心脏重症监护、私人诊所和管理式医疗环境中工作的医生，代表了与AMI患者相关的广泛专业知识。成员们在心脏重症监护、介入心脏病学、核心脏病学、脂质紊乱、超声心动图和心脏康复方面具有专业知识。这些实践指南的目标受众包括所有治疗心肌梗死幸存者的医生。本文讨论了对所有相关临床试验以及其他已发表的关于AMI后自然病史和当前治疗方式效果的数据的文献综述。病例史作为基于文献数据应用的模型。基于科学证据，通过共识投票得出管理建议。当有多种管理选项适用时，建议中会予以说明。建议随正文一同给出。
