medicina54巻11号

2017年10月発行

特集 自信をもって対応する—虚血性心疾患 急性冠症候群の急性期治療

不安定狭心症/非ST上昇型心筋梗塞への急性期治療

著者： 松澤泰志¹ 木村一雄¹

所属機関： ¹横浜市立大学附属市民総合医療センター心臓血管センター

ページ範囲：P.1810 - P.1814

Point
◎不安定狭心症/非ST上昇型心筋梗塞（UA/NSTEMI）は近年増加し，予後不良な疾患である．
◎UA/NSTEMIは幅広い病態のスペクトラムを含む．
◎治療方針決定のためにはリスクの層別化が重要である．
◎UA/NSTEMIの初期薬物治療後の治療戦略として，“routine invasive strategy”と“selective invasive strategy”という2つの異なる考え方がある．

参考文献

1）Roffi M, et al：Management of Acute Coronary Syndromes in Patients Presenting without Persistent STSEotESoC. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation；Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology（ESC）. Eur Heart J 37：267-315, 2016

2）Amsterdam EA, et al：American College of Cardiology, American Heart Association Task Force on Practice Guidelines, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Clinical Chemistry. 2014 AHA/ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes；A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 64：e139-228, 2014

3）Farkouh ME, et al：A clinical trial of a chest-pain observation unit for patients with unstable angina. Chest Pain Evaluation in the Emergency Room（CHEER）Investigators. N Engl J Med 339：1882-1888, 1998

4）Goodacre S, et al：Randomised controlled trial and economic evaluation of a chest pain observation unit compared with routine care. BMJ 328：254, 2004

5）Bavry AA, et al：Benefit of early invasive therapy in acute coronary syndromes；A meta-analysis of contemporary randomized clinical trials. J Am Coll Cardiol 48：1319-1325, 2006

6）Fox KA, et al：Collaboration FIR；Long-term outcome of a routine versus selective invasive strategy in patients with non-ST-segment elevation acute coronary syndrome a meta-analysis of individual patient data. J Am Coll Cardiol 55：2435-2445, 2010

7）O'Donoghue M, et al：Early invasive vs conservative treatment strategies in women and men with unstable angina and non-ST-segment elevation myocardial infarction；A meta-analysis. JAMA 300：71-80, 2008