联合检测肌钙蛋白T、高敏C反应蛋白和B型钠尿肽对非ST段抬高的急性冠状动脉综合征预后诊断的价值

目的探讨联合检测肌钙蛋白T、高敏C反应蛋白、B型钠尿肽对非ST段抬高的急性冠状动脉综合征预后诊断的价值。方法检测145例经冠状动脉造影证实的非ST段抬高的急性冠状动脉综合征患者肌钙蛋白T、高敏C反应蛋白、B型钠尿肽的水平。随访急性冠状动脉综合征患者12个月，观察终点为心肌梗死新发或再发和心源性死亡。结果多因素logistic回归分析发现肌钙蛋白T、高敏C反应蛋白、B型钠尿肽可独立预测非ST段抬高急性冠状动脉综合征患者远期预后。经过已知的临床危险因素校正后，心脏生化标志物异常的数目仍然是其心血管事件重要危险因子。结论联合检测肌钙蛋白T、高敏C反应蛋白、B型钠尿肽对急性冠状动脉综合征患者长期预后有重要的临床价值。     

心电图变化及肌钙蛋白水平对无ST段抬高的急性冠状动脉综合征患者的危险分层与预后预测的价值

目的　探讨心电图变化及肌钙蛋白水平对无ST段抬高的急性冠状动脉综合征患者的危险分层与预后预测的价值。方法　自 2 0 0 0年 7月～ 2 0 0 1年 6月 ,在急诊室因急性胸痛拟诊不稳定性心绞痛及无ST段抬高心肌梗死而收入住院且记录资料完整的连续 2 56例患者。入急诊室后仔细询问病史、查体 ,并在 10min内完成常规 18导联心电图检查 ,将患者入院时心电图的改变分为ST段压低组 (包括伴有T波倒置者 )、单纯T波倒置组、尚不能诊断的心电图组及正常心电图组 ,同时床旁抽静脉血做肌钙蛋白I(TnI)检测。并据TnI水平将患者分成TnI阳性组 (TnI定量检测≥ 0 1μg/L)和TnI阴性组 (TnI <0 1μg/L )。观察各组住院期主要心血管事件 (心脏性死亡、非致命性心肌梗死、反复缺血性心绞痛发作 ) ,并随访 1～ 12 (7 2± 3 8)个月主要心血管事件变化。结果　与正常心电图组比较 ,ST段压低组的反复心绞痛发作及复合心血管事件明显增多。 3 2 1%的不稳定性心绞痛及所有无ST段抬高心肌梗死患者的TnI阳性 ,TnI阳性组有明确冠心病诊断者较TnI阴性组多 ,TnI阳性组较TnI阴性组的住院期非致命性心肌梗死发生率增高 ,住院期与随访期反复心绞痛发作增加 ,总心脏性病死率也上升 ,且复合心血管事件显著增多。对复合心血管事件的预测 ,T     

急性冠脉综合征心肌肌钙蛋白T与血流动力学相关性研究

目的:探讨急性冠脉综合征(ACS)患者心肌肌钙蛋白T(cTnT)与心脏血流动力学参数的相关性. 方法:选择37例ACS患者,男性32例,女性5例,年龄36～84岁.不稳定型心绞痛患者5例、非ST段抬高急性心肌梗死患者6例、ST段抬高急性心肌梗死患者26例.对所有患者进行无创心脏血流动力学检查并收集cTnT等数据.采用S...     

非ST段抬高急性冠状动脉综合征的心电图诊断线索

急性心肌缺血患者根据初始发作时的12导联心电图表现分为：（1）显著的ST段抬高,即ST段抬高急性冠状动脉综合征（STEACS）;（2）无显著的ST段抬高,即非 ST 段抬高急性冠状动脉综合征（NSTEACS）。依据心肌坏死标志物升高与否, NSTEACS又分为不稳定型心绞痛（UA）及非ST段抬高心肌梗死（NSTEMI）,前者血清心肌坏死标志物正常,后者心肌坏死标志物升高[1-3]。     

缺血修饰白蛋白对非ST段抬高急性冠脉综合征患者诊断及危险分层的评价研究

摘要 目的：研究新型心肌缺血标志物缺血修饰白蛋白在非ST段抬高急性冠脉综合征患者的血清水平，探讨缺血修饰白蛋白水平对非ST段抬高急性冠脉综合征患者的疾病诊断、危险分层中的价值。 方法：收集非ST段抬高急性冠脉综合征患者137例（其中非ST段抬高型心肌梗死患者73例，不稳定型心绞痛患者64例），并以120例无急性心肌缺血者作为对照（其中稳定型心绞痛患者37例，冠状动脉粥样硬化患者43例，健康者40例），采集肌钙蛋白指标及GRACE评分，并对所有入院患者采用酶联免疫吸附试验方法检测缺血修饰白蛋白值，对结果进行统计学分析。 结果：①非ST段抬高型心肌梗死患者缺血修饰白蛋白平均水平（118.02±38.14，U/ml），不稳定型心绞痛患者缺血修饰白蛋白平均水平（121.34±53.73，U/ml），稳定型心绞痛患者缺血修饰白蛋白平均水平（95.03±32.78，U/ml），冠状动脉粥样硬化患者缺血修饰白蛋白平均水平（101.65±30.04，U/ml），健康人群缺血修饰白蛋白平均水平（71.87±10.86，U/ml），五组中不稳定型心绞痛患者血清缺血修饰白蛋白平均水平最高，非ST段抬高型心肌梗死患者的缺血修饰白蛋白水平高于稳定型心绞痛患者，差异有统计学意义，不稳定型心绞痛患者的缺血修饰白蛋白水平高于稳定型心绞痛患者，差异有统计学意义；②非ST段抬高型心肌梗死和不稳定型心绞痛患者缺血修饰白蛋白水平与GRACE评分无相关性；③非ST段抬高型心肌梗死和不稳定型心绞痛患者术前、术后24小时内和出院前血清缺血修饰白蛋白水平无差异；④非ST段抬高型心肌梗死和不稳定型心绞痛患者的缺血修饰白蛋白水平与肌钙蛋白I无相关性；⑤血清缺血修饰白蛋白用于诊断非ST段抬高急性冠脉综合征的ROC曲线敏感度为68.7%，特异度为60%，曲线下面积为0.641，血清缺血修饰白蛋白诊断非ST段抬高急性冠脉综合征准确性较低。 结论：非ST段抬高急性冠脉综合征患者新型心肌缺血标志物血清缺血修饰白蛋白的表达水平高于稳定型心绞痛患者；非ST段抬高型心肌梗死和不稳定型心绞痛患者的缺血修饰白蛋白水平无区别；缺血修饰白蛋白水平诊断非ST段抬高急性冠脉综合征准确性较低，目前不能还作为非ST段抬高急性冠脉综合征患者的危险分层的指标。     

腔内影像学指导下急性冠脉综合征发病机制及干预策略进展

<正>急性冠脉综合征(acute coronary syndrome,ACS)是指由于冠状动脉血流突然减少导致急性心肌缺血和/或心肌梗死的一系列现象[1]。ACS包括急性ST段抬高型和非ST段抬高型ACS,其中非ST段抬高型ACS可根据心肌损伤生物标志物(主要是肌钙蛋白cTn)的水平及临床表现,分为急性非ST段抬高型心肌梗死(non ST segment elevation,NSTEMI)和不稳定型心绞痛(unstable angina,UA)。     

非ST段抬高型急性冠状动脉综合征介入治疗对心功能的影响

非ST段抬高型急性冠状动脉综合征包括不稳定型心绞痛和非ST段抬高型急性心肌梗死。非ST段抬高型急性冠状动脉综合征患者往往伴有心功能不全,严重影响患者生存质量和预后。近年来研究表明介入治疗可以使狭窄闭塞的冠状动脉再通,心肌得到再灌注,对非ST段抬高型急性冠状动脉综合征患者心功能改善有很大帮助。     

心脏声学造影在非ST段抬高型急性冠状动脉综合征中的应用

非ST段抬高型急性冠状动脉综合征由于缺乏特异的检查手段,容易造成漏诊、误诊,导致治疗延误,甚至引起患者死亡。因此开发有效的鉴别诊断方法具有重要意义。心脏声学造影是一种可以在急诊室和胸痛中心快速施行的无创影像检查技术,该技术可在床旁同时评价心脏室壁运动和心肌灌注情况而用于各类冠状动脉疾病的诊断。现就心脏声学造影在非ST段抬高型急性冠状动脉综合征中的应用情况做一综述。     

急性脑卒中老年患者心电图ST段抬高的临床意义

目的探讨老年急性脑卒中患者心电图ST段抬高是否具有急性心肌梗死的临床意义。方法选择急性脑卒中合并心电图上相邻两个以上导联ST段抬高、且于脑卒中后3个月～6个月内接受了冠状动脉造影的老年患者46例为研究对象,根据心电图演变、心肌血清标记物检测及冠状动脉造影结果,将患者分为急性脑卒中合并急性心肌梗死的ST段抬高组和非急性心肌梗死的ST段抬高组,进行组间临床特征的分析比较。结果46例急性脑卒中伴ST段抬高的患者中,合并急性心肌梗死者12例,心肌梗死组合并心房颤动、糖尿病、既往冠状动脉性心脏病(冠心病)史、纤维蛋白原水平、心肌型肌钙蛋白I和肌酸激酶同工酶阳性率均显著高于非心肌梗死组(P<0.05或0.01)。心肌梗死组多为ST段弓背向上抬高,幅度多≥0.2 mV,多呈动态演变且伴R波的进行性降低。而非心肌梗死组的ST段抬高多不具有上述特点。结论急性脑卒中所伴发的心电图ST段抬高患者中约30%合并急性心肌梗死,严密观察心电图演变及血清心肌标记物水平可资早期鉴别。     

心肌组织水平再灌注心电图的演变及机制研究进展

急性心肌梗死（AMI）是在冠状动脉病变的基础上发生的冠状动脉血供急剧减少或中断,使相应心肌严重而持久的急性缺血引起的任何面积大小的心肌细胞的坏死,是常见的心血管急危重症.既往WHO定义的急性心肌梗死的诊断标准包括缺血症状、心电图动态改变和血清心肌坏死标志物变化.目前,根据心电图有无ST段抬高将心肌梗死分为ST段抬高型心肌梗死和非ST段抬高型心肌梗死.诊断心肌梗死时,心肌坏死标志物通常于发病2～4小时后出现,而对于ST段抬高型心肌梗死,发病早期即可出现心电图的改变.心电图作为临床常规检查对急性心肌梗死的诊断及再灌注的判断具有简单、快捷、方便、直观的优点,对于ST段抬高型心肌梗死的诊断及再灌注的评价有着极其重要的作用.本文就ST段抬高型心肌梗死心肌组织水平再灌注心电图的演变及其可能的机制加以阐述.     

首次急性ST段抬高与非ST段抬高心肌梗死患者临床及冠状动脉病变特点比较

目的回顾性分析比较首次发生急性ST段抬高心肌梗死与非ST段抬高心肌梗死的临床及冠状动脉病变的特点。方法选择首次急性ST段抬高心肌梗死患者50例(ST段抬高组)和急性非ST段抬高心肌梗死患者50例(非ST段抬高组),均行冠状动脉造影检查,对其发病特点、临床表现、并发症、心功能以及冠状动脉病变进行回顾性分析。结果 ST段抬高组起病急,主要以剧烈胸痛为主,就诊时间较早,非ST段抬高组首发症状多样。ST段抬高组总并发症、室性心律失常、窦性心动过缓及传导阻滞发生率明显高于非ST段抬高组(P<0.01),左心室射血分数明显低于非ST段抬高组(P<0.05)。与ST段抬高组比较,非ST段抬高组冠状动脉病变血管支数较多,3支病变、侧支循环比例较高(P<0.05,P<0.01)。结论急性ST段抬高心肌梗死起病急,并发症多,影响心功能,应积极尽快实施血运重建,以开通梗死相关血管,但急性非ST段抬高心肌梗死冠状动脉病变往往较重。急性心肌梗死的近期预后与起病急缓、透壁性心肌坏死范围等有关。     

The effects of clarithromycin treatment on cardiac events in acute coronary syndrome patients]

OBJECTIVE: The assessment of short duration early clarithromycin treatment on major cardiac events in acute coronary syndrome patients. METHODS: One hundred and thirteen patients with acute coronary syndrome had been enrolled in the study in a prospective manner. Fifty-seven of 113 patients received peroral clarithromycin 1g/day for 14 days in addition to standard therapy. The remaining 56 patients were considered as control group. The treatment and control groups had similar major cardiac risk factors such as diabetes, hypertension, dyslipidemia and smoking habits. The occurrence of unstable angina pectoris, non-ST elevation myocardial infarction and ST elevation myocardial infarction was comparable in both groups. The use of thrombolytic therapy and glycoprotein IIb/IIIa receptor blockers administration was also similar in both groups. The patients were followed for major cardiac events for 6 months. RESULTS: During the follow-up, no difference was observed between groups in the occurrence of unstable angina pectoris, myocardial infarction, the need for revascularization with percutaneous coronary intervention or cardiac surgery and cardiac death. We observed a reduction of myocardial infarction and cardiac death occurrence and an increase in the necessity of percutaneous interventions in the treatment group even though this difference did not reach statistical significance. CONCLUSION: No benefit of short duration early clarithromycin therapy was observed in the occurrence of major cardiac events in acute coronary syndromes. Studies with longer treatment and follow-up period using different antibiotics are necessary to elucidate the possible effect of antibiotics on major cardiac events in patients with acute coronary syndrome.     

床旁检测N末端脑钠肽前体对非ST段抬高性急性冠脉综合征患者的意义

目的探讨非sT段抬高性急性冠脉综合征（Non-STelevationacutecoronarysyndrome,NSTEACS）患者血浆N末端脑钠肽前体（N-terminalpro-B-typenatriureticpeptide,NT-pro-BNP）浓度与冠状动脉病变程度及住院期主要心血管事件的关系。方法入选NSTEACS患者129例,其中不稳定型心绞痛（UA）组84例,非ST段抬高性急性心肌梗死non-STelevationmyocardialinfarction,NSTEMI）组45例,另外选择同期住院的稳定型心绞痛（SA）组58例作为对照组。所有患者均测定血浆NT-pm-BNP浓度及左心室射血分数（LVEF）,行冠状动脉造影术,采用Gensini积分评价冠状动脉病变的严重程度,并记录住院期间主要心血管事件。结果NSTEMI组和不稳定型心绞痛组的血浆NT-pro-BNP浓度及Gensini积分明显高于稳定型心绞痛组,且NSTEMI组高于不稳定型心绞痛组,差异有统计学意义[1g（NT-pro-BNP）：（2．31±0．21）pg／mL vs．（1．92±0．17）pg／mLm（1．46±0．11）pg／mL,P〈0．05;Gensini积分：（36．3±16．7）分VS．（16．3±10．3）分US．（8．7±4．6）分,P〈0．05]。NSTE-ACS组的1g（NT-pro-BNP）与Gensini积分相关（r=0．57,P〈0．05）。NT-pro-BNP〉154pg／mL组主要心血管事件发生率增加。结论床旁检测NT-pro-BNP是预测NSTEACS患者的冠状动脉病变程度及短期预后的有效临床手段。     

Third heart sound revisited: a correlation with N-terminal pro brain natriuretic peptide and echocardiography to detect left ventricular dysfunction

BACKGROUND: Auscultation of the third heart sound is an age-old sign for predicting ventricular dysfunction. New technology and biomarkers like two-dimensional echocardiography and N-terminal pro brain natriuretic peptide, respectively, have sidelined the utility of this sign, which does not involve any cost and is readily accessible. We sought to find the predictive accuracy of third heart sound and its correlation with N-terminal pro brain natriuretic peptide and ejection fraction using two-dimensional echocardiography to detect left ventricular dysfunction in patients of acute coronary syndrome. METHODS AND RESULTS: One hundred and ten patients presenting with acute coronary syndrome [acute ST elevation myocardial infarction (n=74) and non-ST elevation myocardial infarction (n=36)] were prospectively studied. A senior cardiologist, blinded to N-terminal pro brain natriuretic peptide and ejection fraction results auscultated for a left ventricular third heart sound in each patient. Ejection fraction was measured using modified Simpson's technique on two-dimensional echocardiography and N-terminal pro brain natriuretic peptide was measured using electrochemiluminiscence assay. Median levels of N-terminal pro brain natriuretic peptide were used to provide a dichotomous approach for analysis of the data. Third heart sound was present in 40 patients (acute ST elevation myocardial infarction: n=27, non-ST elevation myocardial infarction: n=13) and absent in 70 patients (acute ST elevation myocardial infarction: n=47, non-ST elevation myocardial infarction: n=23). The sensitivity and specificity of third heart sound for predicting N-terminal pro brain natriuretic peptide above median was 65.5% and 92.7%, respectively. The positive and negative predictive value was 90% and 73%, respectively. The N-terminal pro brain natriuretic peptide of those having third heart sound was 4081 +/- 2705 pg/ml compared to 1239.3 +/- 1169 pg/ml in those without third heart sound (p < 0.001). The sensitivity of third heart sound to detect ejection fraction <45% was 67.9% while the specificity was 74.4%. The positive and the negative predictive values were 47.5% and 87.1%, respectively. The ejection fraction of patients having third heart sound was 47.5 +/- 11.3% compared to 56 +/- 10.4% without third heart sound (p < 0.001). CONCLUSIONS: Auscultation of third heart sound has a good specificity and predictive value for predicting elevated N-terminal pro brain natriuretic peptide and left ventricular dysfunction. Thus age-old clinical cardiology still holds its forte in this new era of technology-driven cardiology.     

Akutes Koronarsyndrom mit und ohne ST-Elevation

Coronary artery disease accounts for most deaths in western communities. The acute coronary syndrome subsidizes ST elevation myocardial infarction, non-ST elevation myocardial infarction, and unstable angina pectoris. They are characterized by an acute onset of chest pain.The high number of acute coronary syndromes of more than 400,000 per year in Germany demonstrates the necessity of guidelines. Such guidelines are available from different cardiac societies. The implementation of the guidelines of the German Cardiac Society and the European Society of Cardiology in the daily clinical practice are demonstrated in this review by means of two case presentations. Special attention has been given to diagnostic measures, risk stratification, and different therapeutic options. For the diagnostic work-up in the acute phase, the ECG and the assessment of cardiac biomarkers play the central role. For patients with ST elevation myocardial infarction, primary interventional diagnostics and therapy are the first choice. For patients presenting with acute coronary syndromes without ST elevation, a risk-adapted therapeutic approach should be chosen. High-risk patients (elevated troponins, clinical, rhythmologic, and hemodynamic instability, ST depression, or diabetes mellitus) should be treated with an early invasive approach within 48-72 h. Low-risk patients can be treated primarily conservatively. For all patients who undergo interventional treatment, administration of an aggressive antiaggregatory therapy, including acetylsalicylic acid, clopidogrel, glycoprotein IIb/IIIa receptor antagonists, and heparin, is indicated in the acute phase. In the chronic phase, an adequate treatment of cardiovascular risk factors is of paramount importance.     

老年急性心肌梗死患者发病时间与梗死部位及ST段偏移的相关性

目的 探讨老年急性心肌梗死患者发病时间与梗死部位及ST段偏移的相关性. 方法 对909例老年急性心肌梗死患者(其中包括412例前壁和423例下壁的急性心肌梗死患者)发病时间、部位和ST段抬高及冠状动脉造影等临床资料进行分析. 结果 老年急性心肌梗死患者在清晨6时至中午12时发病为525例(57.8%).24时至清晨6时发生下壁心肌梗死138例(32.6%),与其他时间比较,差异有统计学意义(P<0.01),从清晨6时至中午12时,发生前壁心肌梗死156例(37.9%),与其他时间段比较,差异有统计学意义(P<0.01),516例冠状动脉造影的AMI患者中,24时至清晨6时发病的急性下壁心肌梗死118例,其病变累及右冠状动脉多于累及左冠状动脉[分别为85.6%(101/118)和14.0%(17/118),P<0/013,清晨6时至24时发病的急性下壁心肌梗死275例,其病变累及右冠状动脉与左冠状动脉分别为54/2%(149/275)和45.8%(126/275)(P>0.05);732例急性ST段抬高患者在清晨6时至中午12时发病率最高为44.0%(263/644),265例非ST段抬高的心肌梗死24时至清晨6时发病率最高为36.6%(96/265). 结论 老年急性心肌梗死患者中,夜间非ST段抬高的发生率高于ST段抬高.由于夜间右冠状动脉闭塞所引起的急性下壁心肌梗死多于左冠状动脉,所以睡眠对老年患者的左冠状动脉累及和急性非ST段抬高性心肌梗死的保护作用是有限的.     

三项生化指标联合检测在急性冠状动脉综合征患者临床诊断中的意义

目的探讨心肌肌钙蛋白T(cTnT)和N末端B型钠尿肽前体(NT-proBNP)及高敏C反应蛋白(hs-CRP)3项生化指标联合检测在急性冠状动脉综合征(ACS)临床诊断中的应用价值。方法选择ACS患者134例,其中不稳定性心绞痛(UAP组)患者49例,ST段抬高心肌梗死(STEMI组)患者37例,非ST段抬高心肌梗死(NSTEMI组)患者48例。用电化学发光双抗体夹心法检测cTnT、NT-proBNP,免疫透射比浊法检测hs-CRP;通过绘制ROC曲线和建立logistic回归模型,分析各指标单独和联合检测在UAP、NSTEMI及STEMI诊疗中的作用。结果 UAP组(除外cTnT)、NSTEMI组及STEMI组患者血清cTnT、NT-proBNP、hs-CRP水平明显高于对照组,差异有统计学意义(P<0.05)。与cTnT、NT-proBNP、hs-CRP单独检测比较,3项指标联合检测ACS各组ROC曲线下面积最大,敏感性和特异性最好。结论联合检测cTnT、NT-proBNP、hs-CRP能明显改善ACS中UAP的诊断效果,对于NSTEMI和其他急性心肌梗死也能使敏感性和特异性达到最优化,但对区分NSTEMI和其他急性心肌梗死效果不明显。     

Predictors of myocardial damage prior to hospital admission among patients with acute chest pain or other symptoms raising a suspicion of acute coronary syndrome

AIM: To evaluate factors which, prior to hospital admission, predict the development of acute coronary syndrome or acute myocardial infarction among patients who call for an ambulance due to suspected acute coronary syndrome. DESIGN: Prospective observational study. METHODS: All the patients who called for an ambulance due to suspected acute coronary syndrome in South Hospital's catchment area in Stockholm and in the Municipality of G?teborg between January and November 2000, were included. On arrival of the ambulance crew, a blood sample was drawn for bedside analysis of serum myoglobin, creatine kinase (CK)MB and troponin-I. A 12-lead electrocardiogram (ECG) was simultaneously recorded. RESULTS: In all, 538 patients took part in the survey. Their mean age was 69 years and 58% were men. In all, 307 patients (57.3%) had acute coronary syndrome and 158 (29.5%) had acute myocardial infarction. Independent predictors of the development of acute coronary syndrome were a history of myocardial infarction (P=0.006), angina pectoris (P=0.005) or hypertension (P=0.017), ECG changes with ST elevation (P<0.0001), ST depression (P<0.0001) or T-wave inversion (P=0.012) and the elevation of CKMB (P=0.005). Predictors of acute myocardial infarction were being a man (P=0.011), ECG changes with ST elevation (P<0.0001) or ST depression (P<0.0001), the elevation of CKMB (P<0.0001) and a short interval between the onset of symptoms and blood sampling (P=0.010). CONCLUSION: Among patients transported by ambulance due to suspected acute coronary syndrome, predictors of myocardial damage can be defined prior to hospital admission on the basis of previous history, sex, ECG changes, the elevation of biochemical markers and the interval from the onset of symptoms until the ambulance reaches the patient.     

Spontaneous Coronary Artery Dissection and Hemodynamic Instability: Can Emergent PCI Be Life Saving? Report of Two Cases and Literature Review

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome. It occurs predominantly among younger females and typically in the absence of atherosclerotic coronary artery disease. It is associated with peripartum period, connective tissue disorders, vasculitides, and extreme exertion. Presentations vary greatly, and this condition can be fatal. Given its rarity, there are no guidelines for management of SCAD. We present the cases of two female patients, with no coronary artery disease risk factors or recent pregnancy, who were presented with non-ST elevation myocardial infarction (NSTEMI) and ST elevation myocardial infarction (STEMI), respectively, secondary to SCAD. Both had excellent outcome after emergent percutaneous intervention. Our first patient was presented with NSTEMI with ongoing chest pain and dynamic electrocardiogram (ECG). Emergent left heart catheterization was significant for first obtuse marginal (OM1) dissection, confirmed by optical coherence tomography. Percutaneous coronary intervention (PCI) with two bare metal stents was performed with resolution of symptoms and ECG changes. The second patient is known to have syndrome, presented with STEMI and emergent coronary angiography showed left anterior descending dissection with intramural hematoma confirmed by intravascular ultrasound and treated with a drug-eluting stent with resolution of symptoms and ST changes. Her hospital course was complicated by post–myocardial infarction pericarditis that was improved with colchicine. Both the patients were observed in the coronary care unit for 24 hours. Both remained asymptomatic at 6-month follow-up. SCAD is a rare cause of acute coronary syndrome. In patients with early presentation, limited disease, and ongoing symptoms, emergent cardiac catheterization with percutaneous intervention has excellent outcome. More studies are needed to establish evidence-based management guidelines.     

A population-based evaluation of the thrombolysis in myocardial infarction risk score for unstable angina and non-ST elevation myocardial infarction

BACKGROUND: The Thrombolysis in Myocardial Infarction risk score (TIMI-RS) for unstable angina/non-ST elevation myocardial infarction (MI) was developed in patients presenting with unstable angina accompanied by high-risk features or non-ST elevation MI to determine early risk stratification. HYPOTHESIS: The validity in patients presenting for emergency care with symptoms suggestive of acute coronary syndrome (ACS) has not been well established, and the present study sought to do so by evaluating the TIMI-RS in a prospective fashion. METHODS: A prospective TIMI-RS using seven variables was calculated in 245 patients admitted to the hospital with symptoms suggestive of ACS: (1) age > 65, (2) three or more cardiac risk factors, (3) ST deviation, (4) aspirin use within 7 days, (5) two or more anginal events over 24 h, (6) history of coronary stenosis, and (7) elevated troponin. Patients were contacted at 30 days and data were collected concerning major adverse cardiac events. RESULTS: In patients presenting with chest pain, a higher TIMI-RS was associated with an increase in major adverse cardiac events within 30 days. We found that the 30-day event rate was 0% for a score of 1, 20% for a score of 2, 24% for a score of 3, 42% for a score of 4, 52% for a score of 5, and 70% for a score of 6 or 7 (p < 0.0001). CONCLUSIONS: The TIMI-RS successfully differentiates early risk for major adverse cardiac events in a general population presenting with symptoms suggestive of acute coronary syndrome. A simple bedside calculation of the TIMI-RS provides rapid risk stratification, allowing facilitation of therapeutic decision making in patients with symptoms suggestive of ACS.