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1、AcuteCoronarySyndromes: ManagementofUA/NSTEMIOverviewof2003Updatestothe ACC/AHAGuidelineforUA/NSTEMIAssesslikelihoodofCADRiskstratificationTargettherapy:moreaggressivetreatmentin higher-riskpatientsAnti-ischemic,antithrombotictherapyInvasivevsconservativestrategyDischa
2、rgeplanning(riskfactormodificationand long-termmedicaltherapy)ACC/AHA,AmericanCollegeofCardiology/AmericanHeartAssociation;UA,unstableangina; NSTEMI,non–ST-segmentelevationmyocardialinfarction. BraunwaldE,etal.JAmCol.Cardiol.2000;36:970-1062.AcuteManagementofUA/NSTEMIAn
3、ti-IschemicTherapyOxygen,bedrest,ECGmonitoringNitroglycerin-BlockersACEinhibitorsUA,unstableangina;NSTEMI,non-ST-segmentelevationmyocardialinfarction;ECG,electrocardiogram;ACE,angiotensin-convertingenzyme.BraunwaldE,etal.JAmCollCardiol.2000;36:970-1062.AntithromboticTh
4、erapyAntiplatelettherapyAnticoagulanttherapyPossible ACSAspirinAspirin+IVHeparin+IVPlatelet GPIIb/IIIaAntagonistDefiniteACSWithInvasiveStrategy(Catheterization/PCI)orHighRisk(IIa)*ClopidogrelAspirin+SQLMWH*orIVHeparinLikely/Definite ACSClopidogrel*ClassIIa:enoxaparinpre
5、ferredoverUFHunlessCABGplannedwithin24hours.ACC,AmericanCollegeofCardiology;AHA,AmericanHeartassociation;ACS,acutecoronarysyndrome;PCI,percutaneouscoronaryintervention;SQLMWH,subcutaneouslowmolecular-weightheparin;IV,intravenous.BraunwaldE,etal.JAmCollCardiol.2000;36:97
6、0-1062.ACC/AHAClassIRecommendationsforAntithromboticTherapy*17.16.5*PlaceboASA05101520Patients(%)UnstableAngina25.011.0*ASA01020303.31.9*ASA0123411.89.4*ASA051015AcuteMIAspirininAcuteCoronarySyndromes*P<.0001DeathorMI*P=.003Reocclusion*P=.012MI*P<.001DeathN=397399513419
7、8587860085878600MI,myocardialinfarction;ASA,acetylsalicylicacid;RISC,ResearchonInStabilityinCoronaryarterydisease.RISCGroup.Lancet.1990;336:827-830.RouxS,etal.JAmCollCardiol.1992;19:671-677.ISIS-2.Lancet.1988;2:349-360.PlaceboPlaceboPlaceboAspirininAcuteCoronarySyndrome
8、s12.93.9*ASA05101511.93.3*ASA05101512.96.2*ASA0510152.21.3*ASA00.511.522.5UA/NSTEMIPrimary PreventionStable An
