ACC_AHA 指南_ 不稳定型心绞痛和非ST段抬高型心肌梗死.pptVIP

ACC/AHA GUIDELINES: UNSTABLE ANGINA NON–ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION 王宗倫 醫師 講述引用 Wang, Tzong-Luen,MD, PhD, FACC, FESC Changes in Focus on Heart Failure 建議 危險評估 Class I 1. Noninvasive stress testing in low-risk pts free of ischemia at rest or with low-level activity and of CHF for a minimum of 12 to 24 h. 2. Noninvasive stress testing in pts at intermediate risk who have been free of ischemia at rest or with low-level activity and of CHF for a minimum of 2 or 3 days. 危險評估 Class I 3. Choice of stress test is based on the resting ECG, local expertise, and technologies. Treadmill exercise in pts able to exercise in whom the ECG is free of baseline ST-segment abnormalities, BBB, LVH, intraventricular conduction defect, paced rhythm, pre-excitation, and digoxin effect. 4. An imaging modality in pts with resting ST-segment depression (0.1 mV), LVH, BBB, IVCD, pre-excitation, or digoxin who are able to exercise. 非侵襲性危險評估 1. Severe LV dysfunction (LVEF 0.35), rest or exercise 2. High-risk treadmill score (score -11) 3. Stress-induced large perfusion defect 4. Stress-induced multiple perfusion defects 非侵襲性危險評估 5. Large, fixed perfusion defect with LV dilation or increased lung uptake 6. Stress-induced moderate perfusion defect with LV dilation or increased lung uptake 7. Echocardiographic wall motion abnormality (2 segments) at a low dose of dobutamine ( 10 mg?kg-1 ?min-1) or at a low heart rate (120 bpm) 1. Mild/moderate resting LV dysfunction (LVEF 0.35-0.49) 2. Intermediate-risk treadmill score (-11 score 5) 3. Stress-induced moderate perfusion defect without LV dilation or increased lung intake 4. Echocardiographic ischemia with wall motion abnormality involving 2 segments only at higher doses of dobutamine 在30 天時死亡或心肌梗塞率 出院時藥物 1. Aspirin 75 to 325 mg/d 2. Clopidogrel 75 mg/qd for patients with contraindication to ASA 3. ?-Blocker 4. Lipid-lowering agent and diet in patients with LDL cholesterol 130 mg/dL 5. Lipid-lowering agent if LDL ch