CAPTURE PR ISM 2PLUS PURSU IT,

903 1005-2194 (2007) 12-0903 - 05 ESC ST R5 A 100029 :, E2mail: chshma@ vip1sina1com,,,, :,,,, 300, 10 ; ST ACS; Keywords Coronary disease; Non2ST2segment elevocteal ACS; Guideline ST (NSTE2ACS) (UA) ST (NSTEM I), UA NSTEM I,, NSTEM I UA NSTEM I, ( EuroHeart Survey) 2000 9 2001 5 25 103, NSTE2ACS 6 12% [ 1 ], NSTE2ACS, NSTE2ACS, [ 2-3 ] ( European society of cardiology, ESC) 2002 ST NSTE2ACS, ( b / a ) NSTE2ACS NSTE2ACS, ( PC I) ( CABG),, 1 ( GP) b / a NSTE2ACS NSTE2ACS, PC I GP b / a PC I, NSTE2ACS GP b / a NSTE2ACS, GP b / a 3 GP b / a PR ISM 2PLUS, 7 d (1219% 1719%, P < 0101), 30 d 6, PC I [ 4 ] PURSU IT GP b / a NSTE2ACS, 10 948,, 30 d, 72 h PC I, (117% 515%, P < 01001),, 6 ( 2716% 3217%, P < 0105), ST [ 5 ], CAPTURE PR ISM 2PLUS PURSU IT, GP b / a 34% ST GP b / a PC I 48 h 41% [ 6 ] ST, ( PC I CABG), GP b / a ST, NSTE2ACS GP b / a, 31 402 NSTE2ACS, GP b / a

904 CH INESE JOURNAL OF PRACTICAL INTERNAL MED IC INE Jun 2007 Vol127 No112 30 d 9%, [ 7 ],, ( TIM I > 4),, [ 8 ], GUSTO IV2ACS, ACS,, [ 9 ] ACC /AHA, ST PC I, [ 2 ] 2 ST ESC NSTE2ACS, (1)(2) ST [ ST > 011 mv ( < 30 m in ) ST < 011 mv ] (3) T 2 (CK2MB) ( 4) FR ISC, TACTICS2TIM I18 (5) () ( 22 h, FR ISC 5 7 d), (6) (7), NSTE2ACS, : (1) 65 (2),, PC I CABG (3) (4) (C 26) (5) N2 (6) 3 ST, PC I CABG,,, 20 90, ST,, 1 1 TIM I b NSTE2ACS,, 1,, NSTE2ACS [ 10 ] VANQW ISH 920, 23,, CABG 30 d (12% ) [ 11 ] TIM I b VANQW ISH b / a, TIM I b VANQW ISH, 3, FR ISC 2457, 6 d ( 1222 ) (1235 ),, 6 M I 22% ( 1211% 914%, P = 01031),50% 1, ( ) 1014%, 1411% ( P = 01005) 100 NSTE2ACS 117, 2 M I, 20 [ 12 ] TACTICS2TIM I18 2220 (4 48 h ) (, ), 2 Tirofiban 6 ( M I ) ( 1914% 1519%, P = 010025), M I ( 915% 713%, P < 0105) NSTE2ACS ( TI2 M I 3, ST ) [ 13 ], R ITA23 1810 UA /NSTEM, (, n = 895) (, n = 915), Enoxaparin GP b / a, 4( ) ( 916% 1415%, P = 01001), 50%, [ 14 ] Fox [ 15 ] R ITA23 5, 20%, 16% 32% ( 713% 1016%, P = 01026) (, ), 80%,, ICTUS,, NSTE2ACS,

905 1, ( 2117%, 2014%, P = 0159), ( 14165% 914% ), ICTUS 2 (CK2MB), 50% CK2MB 3 [ 16 ] 7 9212 17,, 60%, 36%, 1999 3, [ 17 ] FR ISC TACTICS2TIM I18 R ITA23 3,, NSTE2ACS ESC [ 3 ],,,, (1) NSTE2ACS,? (2),, ISAR2COOL ( 215 h), FR ISC ( 7 d),, ESC 48 h, [ 3 ], ISAR2COOL, 3 5 d, ( ) 30 d (1116% 519%, P = 0104), 1 2 d [ 18 ] ( 3),,, NSTE2ACS, CABG, NSTE2ACS 4,,,, ACS ACS,, NSTE2ACS ; : (1) 75 150 mg/d,,, (2) CURE 12 562 NSTE2 ACS,, 20% PC I NSTE2ACS, NSTE2ACS 9, 12 [ 19 ] (3), 2 12% [ 20 ], 29% [ 21 ] 2 2, 2 (4),(LDL2Ch), PURSU IT PR ISM PR ISM 2PLUS TACTICS, ACS R IKS2H IA, ST 1 [ 22 ], (5)(ACE I), ACE I NSTE2ACS, HOPE EUROPA, ACE I 20% 22% [ 23-24 ] 5,, NSTE2ACS,, GP b / a

906 CH INESE JOURNAL OF PRACTICAL INTERNAL MED IC INE Jun 2007 Vol127 No112 NSTE2ACS ( ),,, NSTE2ACS, NSTE2ACS [ 1 ] Battler A. European Heart Survey of Acute Coronary syndromes [ J ]. Eur Heart J, 2002, 23: 1190-1201. [ 2 ] B raunwald E, Antman EM, Beasley JW, et al. ACC /AHA 2002 guideline update for the management of patients with unstable an2 gina and non2st segment elevation myocardial infarction2summary article: a report of the American College of Cardiology/American Heart A ssociation Task Force on practice guidelines(committee on the Management of PatientsW ith Unstable Angina) [ J ]. J Am Coll Cardiol, 2002, 40: 1366-1374. [ 3 ] Bertrand ME, Simoons ML, Fox KA, et al. Management of acute coronary syndromes in patients presenting without persistent ST2 segment elevation. ( Erratum in Eur Heart J 2003; 24: 1174-5 ) [ J ]. Eur Heart J, 2002, 23: 1809-1840. [ 4 ] The PR ISM2PLUS Study Investigators. 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[ 8 ] Gluckman TJ, Sachdev M, Schulman SP, et al. A simplified ap2 p roach to the management of non2st2segment elevation acute coro2 nary syndromes[ J ]. JAMA, 2005, 293: 349-357. [ 9 ] SimoonsML, A rm strong P, Califf R, et al. Effect of glycop rotein b / a recep tor blocker abciximab on outcome in patients with a2 cute coronary syndromes without early coronary revascularisation: the GUSTO IV2ACS random ised trial [ J ]. Lancet, 2001, 357: 1915-1924. [ 10 ] Anonymous. Effects of tissue p lasminogen activator and a compar2 ison of early invasive and conservative strategies in unstable angi2 na and non2q2wave myocardial infarction. Results of the TIM I B trial. Thrombolysis in myocardial ischem ia [ J ]. Circulation, 1994, 89: 1545-1556. [ 11 ] Boden W E, OπRourke RA, Crawford MH, et al. Outcomes in pa2 tients with acute non2q2wave myocardial infarction randomly as2 signed to an invasive as compared with a conservative manage2 ment strategy. 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907 ised, double2blind, p lacebocontrolled, multicentre trial ( the EU2 ROPA study) [ J ]. Lancet, 2003, 362: 782-788. 2006-09 - 10 : 1005-2194 (2007) 12-0907 - 04 2004 ACC /AHA ST, R5 A :, 100037 E2mail: yyj@ fuwihosp ital. org,,,,, 9 863, 12 1 1 4, 1999 100 ; ST ; Keywords Myocardial infarction; ST segment elevated; Guideline (ACC) (AHA ) 2004 ST ( STEM I),,, STEM I,, [ 1 ] 1 STEM I : a b,,,,; ; a b ( reasonable to perform) (may be considered) 2 STEM I, (ACS),,, STEM I STEM I(NSTEM I),, ( ) ( ) STEM I,, (AM I) 3 : (1) AM I : ( 10 > 20% ), ( ) (2) AM I ( ),, 014 mg 5 m in, AM I,, ( 3) AM I : ( 1 m in ), ( 8 m in ), 12 ( ECG),, AM I 2 h (120 m in) ( PC I), 30 m in ( a ), STEM I ( PC I CABG) : (1) (2) ( 3) ( ) 3 STEM I 311, AM I,, STEM I, 15 m in 12 h, PC I 30 m in, 90 m in PC I,, ECG,, ; 10 m in ECG,,