培训课件--非ST段抬高心肌梗死治疗从临床实践到指南.pptVIP

* According to the 2002 ACC/AHA guidelines, anti-ischemic therapy in patients with NSTE ACS should include (class I recommendation, weight of evidence: C) bed rest with continuous ECG monitoring, nitroglycerin, supplemental oxygen, and morphine (in patients with persistent pain despite therapy with nitroglycerin, those with acute pulmonary congestion, or those with severe agitation). The guidelines also recommend (class I recommendation, weight of evidence: B) the use of an ACE inhibitor in patients with diabetes and those with left ventricular systolic dysfunction or congestive heart failure in whom hypertension persists despite therapy with nitroglycerin and a ?-blocker. The use of an ACE inhibitor is also recommended (class IIa recommendation, weight of evidence: B) in patients with previous ACS. * Additional anti-ischemic therapies recommended by the guidelines include ?-blockers (unless contraindicated; class I recommendation, weight of evidence: B), non-dihydropyridine calcium antagonists in patients with continuing/frequent ischemia in whom ?-blockers are contraindicated and who do not have severe left ventricular dysfunction (class I recommendation, weight of evidence: B), and long-acting calcium antagonist in combination with nitroglycerin and a ?-blocker in patients with recurrent ischemia (unless contraindicated; class IIa recommendation, weight of evidence: C). Routine use of extended-release non-dihydropyridine calcium antagonist instead of a ?-blocker or immediate-release dihydropyridine calcium antagonist in conjunction with a ?-blocker is not recommended (class IIb recommendation, weight of evidence: B). * Reference: 1. Antithrombotic Trialists’ Collaboration. BMJ 2002; 324: 71–86. Since the previous ATTC meta-analysis, much more information has become available from both direct and indirect comparisons of ASA doses. The present analyses indicate that high doses of 500–1500 mg ASA daily (which are more gastrotoxic) are no more effective than m