文档介绍：11/02 1 The Management of Patients with Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction ACC/AHA Pocket Guidelines November, 2002 11/02 2 ACC/AHA Classifications Expert Opinion and mendations Class I Conditions for which there is evidence and/or general agreement that a given procedure or treatment is beneficial, useful, and effective Class II Conditions for which there is conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of a procedure or treatment – Class IIa weight of evidence/opinion is in favor of usefulness/efficacy – Class IIb usefulness/efficacy is less well established by evidence/opinion Class III Conditions for which there is evidence and/or general agreement that the procedure/treatment is not useful/effective and in some cases may be harmful 11/02 3 II. Initial Evaluation and Management A. Clinical Assessment B. Early Risk Stratification C. Immediate Management 11/02 4 A. Clinical Assessment mendation for Initial Triage ? Class I 1. Patient with possible ACS should not be evaluated solely over the telephone but should be referred to a facility that allows evaluation by a physician and the recording of a 12-lead electrocardiogram (ECG) 2. Patients with a suspected ACS with chest fort at rest for >20 minutes, hemodynamic instability, or recent syncope or presyncope should be strongly considered for immediate referral to an emergency department or a specialized chest pain unit 11/02 5 B. Early Risk Stratification mendation ? Class I 1. Patients who present with chest fort should undergo early risk stratification that focuses on anginal symptoms, physical findings, ECG findings, and biomarkers of cardiac injury 2. A 12-lead ECG should be obtained immediately in patients with ongoing chest fort 11/02 6 B. Early Risk Stratification mendation ? Class I 3. Biomarkers of cardiac injury should be measured in all patients who present with chest fort consistent with