急性冠脉综合征的危险分层与处理

The risk stratification and treatment of acute coronary syndromes

急性冠脉综合征可分为ST段抬高型心肌梗死、非ST段抬高型急性冠脉综合征,后者包括非ST段抬高型心肌梗死和不稳定性心绞痛。非ST段抬高型急性冠脉综合征表现多样,按照缺血危险因素进行危险分层,缺血危险越高的患者越需要及早冠脉介入治疗。ST段抬高型心肌梗死则应根据发病的时间尽早再灌注治疗。急性冠脉综合征均应评估出血危险,在标准抗栓的基础上,适当调整抗栓方案,降低出血危险。综合评估缺血和出血危险,及时挽救缺血的心肌、恢复冠脉血供,减少严重出血事件,才能使急性冠脉综合征患者获益最大化、改善预后。

Acute coronary syndromes(ACS)can be classified into ST-segment elevation myocardial infarction(STEMI)and non-ST-segment elevation acute coronary syndrome(NSTE-ACS),which includes non-ST-segment elevation myocardial infarction(NSTEMI)and unstable angina(UA).According to ischemia risk factors evaluation,the coronary lesions of NSTE-ACS are diverse,and the higher the ischemia risk of patients,the earlier coronary interventional treatment is needed.STEMI should be treated with coronary reperfusion as early as possible according to the time of symptom onset.ACS patients should be assessed the risk of bleeding,and the antithrombotic therapy should be adjusted to reduce bleeding events.Balance the risk of ischemia and bleeding,save the ischemia heart muscle,restoring coronary blood supply,and reducing severe bleeding events can maximize the benefits and improve the prognosis of ACS patients.