不稳定性心绞痛

Clinical pathway of Interventional therapy based on Unstable

Angina

A.Standard hospitalization process

(a)Applicable objectives

The first diagnosis is unstable Angina（ICD-10：I20.0/20.1/20.9）

Underwent coronary stenting（ICD-9-CM-3：36.06/36.07）

(b)Diagnosis basis

《Clinical Practice Guidelines - Department of Cardiology》（Edited by Chinese Medical Association, People's Health Publishing department, 2009), 《Unstable Angina and non-ST-segment elevation myocardial infarction diagnosis and treatment guidelines 》(Cardiology Branch of Chinese Medical Association,2007) and the 2007 ACC / AHA and ESC guidelines.

1.Characteristics of clinical onset: the clinical manifestation is

Exercise-induced chest pain or Spontaneous chest pain, it will be quickly relieved when take a rest or sublingual administration of nitroglycerin.

2.The ECG: ST-segment depression or elevation> 0.1mV on adjacent

two or more than two-lead ECG or T-wave inversion ≥0.2mV when chest pain is onset, the changes in ST-T segment recover itself when the chest pain get relieved.

3.Markers of myocardial injury are not elevated or not reach the level

of diagnosis of myocardial infarction

4.Clinical types

1)Initial onset of angina: the new-occurred angina, which has the

largest disease course of a month,can be manifested as Spontaneous and exertional angina onset exist at the same time, and the pain grading is above level III.

2)Worsening exertional angina: patient has a angina history, and the

angina get worsened, it attacks frequently, and the onset time is becoming longer and longer, the pain threshold is getting lower and lower(Canada exertional angina grade [CCS I-IV] increased by at least one class or reached at least Class III)

3)Resting angina: angina attacks when patients are at rest or at a

quiet state, and seizure duration is usually more than 20 minutes.

4)Postinfarction angina: it refers to the angina occurred between 24

hours and a month after the onset of acute myocardial infarction.\

5)Variant angina: the angina attacks when the patients are at rest or

engaged in general activities, electrocardiogram showed a transient elevation of the ST segment when angina is onset, most patients will recover automatically, while a few patients get evolved into myocardial infarction.

（C）Therapy selection and basis

《Clinical Practice Guidelines - Department of Cardiology》（Edited

by Chinese Medical Association, People's Health Publishing department, 2009), 《Unstable Angina and non-ST-segment elevation myocardial infarction diagnosis and treatment guidelines 》(Cardiology Branch of Chinese Medical Association,2007) and the 2007 ACC / AHA and ESC guidelines.

1.Risk stratification: we divide it into low-risks, medium-risks and

high-risk groups according to TIMI risk score or the angina type and severity of the patient, duration of myocardial ischemia,ECG and cardiac injury markers measurement results

2.Drug therapy: anti-ischemic drugs, antiplatelet drugs, anticoagulant

drugs, lipid regulating drugs.

3.Coronary artery revascularization therapy: medium-risk and

high-risk patients can have a preferred choice of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) on the basis of intensive drug therapy.

1).PCI: under the following circumstances, we can have an

emergency coronary angiography in 2 hours, and implement the PCI therapy for the patient who doesn’t have severe combined diseases and coronary lesions suitable for PCI .

①Resting or a small amount of exercise still accompanied by

repeatedly angina and ischemia on the basis of intensive drug therapy;②Myocardial markers elevate (TNT or TNI)③The