非ST段抬高急性冠脉综合征的危险分层和治疗策略

Risk stratification and therapeutic strategy for patients with non-ST-elevation acute coronary syndrome

临床上 ,非ST段抬高急性冠脉综合征 (ACS)包括不稳定型心绞痛和非Q波心肌梗死 ,极为常见 ,根据临床、心电图、血清生化、左心功能状态和冠状动脉 (冠脉 )病变作危险分层对治疗策略的制定尤为重要。尽管内科保守治疗已普遍采用 ,但对心绞痛反复发作、ST段压低、TnT或TnI增高、血流动力学或心电不稳定、心肌梗死后早期不稳定型心绞痛等高危患者 ,应尽早行冠脉造影 ,并根据冠脉病变情况决定行介入治疗 (最好联合应用血小板GPⅡb/Ⅲa受体阻滞剂 ) ,以改善患者的临床预后。

Acute coronary syndrome(ACS) without ST-segment elevation including unstable angina and non-Q wave myocardial infarction is common in clinical practice. Risk stratification based upon clinical and ECG features, serum biochemical assessment,status of left ventricular function and coronary artery disease provides important therapeutic and prognostic implications. Despite extensive application of conservative treatment, early coronary angiography and/or intervention are strongly recommended for high-risk patients with recurrent angina, ST depression, serum Tn T or I elevation, hemodynamic and electrical unstablity, and postinfarctional angina. The application of platelet GPⅡb/Ⅲa receptor inhibitors may be preferable in this setting. These measureshave been shown to exert a beneficial effect on the prognosis of the patients.