Підхід до пацієнтів із гострими коронарними синдромами

* Morphine should be used judiciously (eg, if nitroglycerin is contraindicated or if the patient has symptoms despite nitroglycerin therapy). Data suggest that morphine attenuates activity of some P2Y12 receptor inhibitors and may contribute to worse patient outcomes (Kubica J, Adamski P, Ostrowska M, et al: Morphine delays and attenuates ticagrelor exposure and action in patients with myocardial infarction: the randomized, double-blind, placebo-controlled IMPRESSION trial. Eur Heart J 37(3): 245–252, 2016. doi: 10.1093/eurheartj/ehv547 and Meine TJ, Roe MT, Chen AY, et al: Association of intravenous morphine use and outcomes in acute coronary syndromes: results from the CRUSADE Quality Improvement Initiative. Am Heart 149(6):1043-1049, 2005. doi: 10.1016/j.ahj.2005.02.010).

† Complicated means that the hospital course was complicated by recurrent angina or infarction, heart failure, or sustained recurrent ventricular arrhythmias. Absence of any of these events is termed uncomplicated.

‡ CABG is still generally preferred to PCI for patients with the following:

• Left main or left main equivalent disease

• Left ventricular dysfunction

• Diabetes

Also, lesions that are long or near bifurcation points are often not amenable to PCI.

CABG = coronary artery bypass grafting; GP = glycoprotein; NSTEMI = non–ST-segment elevation MI; MI = myocardial infarction; PCI = percutaneous intervention; STEMI = ST-segment elevation MI.