Abstracts
Résumé
On distingue maintenant les syndromes coronariens aigus avec ou sans élévation (ou sus-décalage) du segment ST. Les premiers correspondent à une occlusion complète durable d’une artère coronaire et nécessitent un traitement de désobstruction en urgence, par thrombolyse intraveineuse ou par angioplastie. Dans les syndromes coronariens aigus sans élévation du segment ST, la stratification du risque est un élément fondamental de la prise en charge, permettant de distinguer les formes nécessitant une exploration coronarographique précoce et celles dont le diagnostic reposera sur des examens non invasifs. Parmi les facteurs de mauvais pronostic, il faut retenir essentiellement la répétition des douleurs de repos, l’existence de modifications du segment ST sur l’électrocardiogramme et l’augmentation des marqueurs biologiques de nécrose myocardique. Dans tous les types de syndromes coronariens aigus, un traitement de prévention secondaire est impératif pour tenter de freiner l’évolution de la maladie athéroscléreuse.
Summary
There are two types of acute coronary syndromes : those with or without ST-segment elevation. The former require urgent therapeutic measures to reopen the culprit artery (intravenous thrombolysis or primary percutaneous coronary intervention). For the latter, risk stratification is essential and is based upon clinical and biochemical markers. Among them, recent and repeated anginal attacks, ST-segment modifications on admission electrocardiogram, and increased markers of myonecrosis (particularly increased troponin levels) are strong predictors of untoward outcome. According to the risk profile, the initial management is based upon an invasive strategy with powerful antithrombotic medications and urgent angiography, or upon a non-invasive strategy using stress testing, preferably coupled with myocardial imaging techniques. In all instances, secondary prevention measures are determinant to try and stop the progression of the atherosclerotic disease.
Appendices
Références
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