文档介绍：The Management of Patients with Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction
ACC/AHA Pocket Guiderkers of cardiac injury should be measured in all patients who present with chest discomfort consistent with ACS. A cardiac -specific troponin is the preferred marker, and if available, it should be measured in all patients. Creatine phosphokinase-MB isoenzyme (CK-MB) by mass assay is also acceptable. In patients with negative cardiac markers within 6 hours of the onset of pain, another sample should be drawn between 6 and 12 hours
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B. Early Risk Stratification Recommendation
Class IIb
1. C-reactive protein (CRP) and other markers of inflammation should be measured
Class III
1. Total CK (without MB), aspartate aminotransferase (AST), serum glutamic oxaloacetic transaminase (SGOT), -hydroxybutyric dehydrogenase and/or lactate dehydrogenase for the detection of myocardial injury
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Short-Term Risk of Death or Nonfatal MI in Patients with Unstable Angina
High-Risk ( 1 of the Following Features Must be Present)
History Accelerating tempo of ischemic symptoms in preceding 48 h
Character of pain Prolonged ongoing (> 20 min) rest pain
Clinical findings Pulmonary edema, most likely related to ischemia New of worsening MR murmur S3 or new / worsening rales Hypotension, bradycardia, tachycardia Age >75 yrs
ECG findings Angina at rest, with transient ST-segment changes Bundle-branch block, new or presumed new Sustained ventricular tachycardia
Cardiac markers Elevated (eg. TnT or TnI > ng/ml)
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Short-Term Risk of Death or Nonfatal MI in Patients with Unstable Angina
Intermediate-Risk (Must have 1of the Following Features)
History Prior MI, peripheral or cerebrovascular disease, or CABG; prior aspirin use
Character of pain Prolonged (> 20 min) rest angina, now resolved, with moderate or high likelihood of CAD Rest anigna (< 20 min or relieved