Diagnosis and Management of Patients with Suspected Acute Myocardial Infarction
Diagnosis and Management of Patients with Suspected Acute Myocardial Infarction
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疑似急性心肌梗死患者的诊断和治疗
DOI：
10.1080/00365510500236028
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发表时间：
2005
影响因子：
2.1
通讯作者：
B. Lindahl
中科院分区：
文献类型：
--
作者：
B. Lindahl
因疑似急性心肌梗塞 (MI) 入院的患者对治疗医生来说构成了诊断、预后和治疗方面的挑战。心肌坏死标志物升高以及缺血症状和/或缺血性心电图变化对于诊断急性心肌梗死是必须的。肌钙蛋白 T 或 I 是心肌坏死的首选标志物。诊断过程应尽快开始。事实证明，在 ST 段抬高型心肌梗死的情况下，引入院前心电图记录和院前溶栓治疗可以大大缩短从症状出现到接受治疗的时间，这也可以挽救生命。相比之下，院前生化标志物分析的价值数据仍然有限。对于入院时没有 ST 段抬高的患者，诊断取决于心肌损伤标志物的重复测量，这些标志物与其他生化标志物（例如 CRP 和 BNP/NT-proBNP）一起也可用于风险评估。被确定为未来心脏事件风险较低的患者可能会提前出院，相反，对于被确定为高风险的患者可能会开始更强烈的治疗。肌钙蛋白浓度升高可识别受益于抗血栓治疗和侵入性手术的患者。基于临床变量、心电图变化和生化标记物组合的几种不同的风险评分模型已被证明可以进一步改善风险评估和治疗选择。
Patients admitted with suspected acute myocardial infarction (MI) constitute a diagnostic, prognostic and therapeutic challenge for the treating physician. Elevation of a marker of myocardial necrosis together with ischemic symptoms and/or ischemic ECG changes are mandatory for the diagnosis of acute MI. Troponin T or I is the preferred marker of myocardial necrosis. The diagnostic process should start as soon as possible. The introduction of prehospital ECG recordings and prehospital administration of thrombolytic treatment in case of ST‐segment elevation MI, have been shown to decrease the time from onset of symptoms till treatment considerably, which also translates into saved lives. In contrast, data of the value of prehospital analyses of biochemical markers are still limited. In patients without ST‐segment elevation on admission the diagnosis is dependent on repeated measurements of markers of myocardial damage, which together with other biochemical markers (e.g. CRP and BNP/NT‐proBNP) also are useful for risk assessment. Patients identified to be at low risk of future cardiac events might be discharged early and, on the contrary, a more intense treatment might be started in patients identified to be at high risk. An elevated troponin concentration is shown to identify patients who benefit from antithrombotic therapy and invasive procedures. Several different risk scoring models based on a combination of clinical variables, ECG‐changes and biochemical markers, have been shown to further improve risk assessment and selection of treatment.
影响因子：
37.8
作者：
Kim, RJ;Chen, EL;Judd, RM
通讯作者：
Judd, RM