cg95 migrated
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C<GH H GH: GGGGHC<GH H GH: GGGGH GG GG
C I
IG<: 24 &< 2010
..I/I/95
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CHHGCHHG
"HIH .......................................................................................................................................................................... 4
G-H .......................................................................................................................................................... 6
$M HG HH................................................................................................................................ 7
GHH KH< IH <GH ......................................................................................................................................... 7
GHH KH< GH <GH ........................................................................................................................................ 7
1 I .............................................................................................................................................................................10
1.1 J H KH< <GH ...................................................................................................... 10
1.2 GH KH< IH <GH ........................................................................................................................ 11
1.3 GH KH< GH <GH ....................................................................................................................... 18
2 HG H< G H< I .........................................................................................................................29
3 "HH ...............................................................................................................................................................30
4 +G< HG .......................................................................................................................................31
4.1 CGH-HJGG IHG C M <M I IH GHIHJ CAD
KH< H-HJ IH M GMG .......................................................................................................... 31
4.2 J G KH< IH <GH ...................................................................................... 31
4.3 +S H< IG H< J KH< <GH ............................................................................ 32
4.4 EGHG< H GHM K< I H GGGGH GH ... 33
4.5 CGH-HJGG IHG C M <M KH< IH HGH H<
GG .......................................................................................................................................................................... 34
4.6 "H IH GH L HGHG.................................................................................................... 34
5 H< JGG H<G I.................................................................................................................................36
5.1 FI I............................................................................................................................................................................... 36
5.2 "H H< I ..................................................................................................................................................... 36
6 +H "CE I..................................................................................................................................................37
7 H H< I ..................................................................................................................................................38
AL A: < I DJH I "CE H H ...................................................39
I DJH I .................................................................................................................................................. 39
Chest pain of recent onset (CG95)
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C-H D &G ............................................................................................................................................................. 41
"CE H H ........................................................................................................................................................................... 41
AL B: < I +JK ..................................................................................................................42
AL C: < H<G............................................................................................................................................43
AIH H<G I ...........................................................................................................................................................44
Chest pain of recent onset (CG95)
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<G I HM G A73.
<G I G H< GG *21 *68.
"HIH"HIH
<G I HM IHG "CE H<M G I 73 (IG< J
2003).
+H 1.3.6.1 H<G I G H 1.1 "CE H<M
G I 73. < "CE H<M G I GIH IHG
J.
CHG IG <GH GH, GI< G IH M GM , <J
HHM GG, <GG H< H H IH GG.
HHG J H J GMHG , < H< H<G I.
<G I JG H< GGGGH GG KH< H GH <GH
GH GIGH . " K<H< <GH M
H< K<H< H<G I G JH, I HG G<I H H IH.<G I H< G'G <GHM <GH , H< JGI G HG, <GHM
G< <H GG M JIG HHH, JIG JGHHG <GH .
F H<H G GIGH H , H< HK GH GH H<KMG GH
H< I. < SGH G KH< IH <GH GIGH IH M
GM, H< G G KH< HHHH GH <GH K< GH G
GIGH. < I IG <K H H K<H< M G< G H< IG
H< <GH <K H H< <GH K< GGGG JGHH.
AG G GG, H< HG H<G I <J GH H< K<< H<M
K IH K H< GH H<KMG. BIH, G H< M IHHG H <
G H, H <G GGM H I IH GG- H J H
HG GJ HG.
< H<G GH L C G<K H< HK GH H<KMG.
Chest pain of recent onset (CG95)
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<G I G H J H< GG H <GH H<H G IH H H<
<H ( L, HIH <GH K IM, <G NGH H) K< M G<
<G LI. < I G GG H<H KH< GG M
HM GG, <GH GH G H GGM .
< H '<GH ' G IG H<I<IH H< I H <GH GH.
< I K GGI H<H GG K IG I'G GIM IH <HGHG H
GG KH< JI HHG.
Chest pain of recent onset (CG95)
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G-H G-H
<G I G GH H J H< K< GH KH< H <GH
GH GIGH .
HH G<I H H IH 'G G G. KH< H
<GH GH GIGH G<I <J H< HIHM H
GG IH H< HHH, HG< KH< H< <H< GGG. "
H <J H< HM H GG, <H< GGG G<I K H<
DHH !H<'G J GH H< H H<H G H< &H
CHM AH. " G, <H< GGG G<I K J GH H< G<
JH.
IH HK <H< GGG H< G KH< <GH G GGH.
"H G<I GIH M J-G KHH H H H H< G'G G. "H
G<I G H<H H< G M LIG, HIM K< H< IG H< <GH
G IK. < HG GIG H JM GH H< JGHHJ GG G<I
M L. "JGHHG, HHH , H< H J IH
H<, G<I IHIM H. "H G<I G GG H KH< H G
GI< G <MG, GGM GHG, H K< H G EG<.
" H< G G, G G G<I <J H< HIHM H JJ GG
IH HHH .
FG G G<I G J H< H GIH H<M .
Chest pain of recent onset (CG95)
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$$M HG HHM HG HH
P'e(e#)a)i$# ,i)h ac*)e che() %ai#
GH 12- H (EC) G G G GG. < ,
G H< GIHG H <GH H<M J GG. + G H< EC
G<I H M HG H <GH.
D H LI IH M GM (AC) K< <J GH 12-
EC.
D H IHM GH LM, IH H LM GHIH IG IG LHM G
G G GG, M <GH GG. M GIH LM H:
KH< LM GHIH (2) GG H< 94% K< H H G
<M GHM I, 2 94P98%
KH< < GHIHJ IM GG K< H G <M
GHM I, H <J HH 2 88P92% IH G MGG G
J.
D H GGGG GMHG AC HM H< IG. < G
GMHG AC H H< IG.
P'e(e#)a)i$# ,i)h ()ab!e che() %ai#
DG GH G H< K:
GGGGH
GGGGH IG GH HGH (H<H G, H HGH GHIHJ
M HM GG CAD / IH HGH M G<).
" <J HIG HM G GGGGH H< GHH
< CAD G H H< 90% (G H 1), IH< GH JGHH G
IGGM. & G .
1 1 H GHH H <H GHH H <JJ M HM GG H HMHM M HM GG H HMHM
GMHG, , GGMHG, , GL G HGL G HG
- <GH - <GH AHM AHM M M
Chest pain of recent onset (CG95)
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& & &
A (MG) ! ! ! ! ! !
35 3 35 1 19 8 59 2 39 30 88 10 78
45 9 47 2 22 21 70 5 43 51 92 20 79
55 23 59 4 25 45 79 10 47 80 95 38 82
65 49 69 9 29 71 86 20 51 93 97 56 84
F H< 70 KH< HM HM GMHG, GGI GHH > 90%.
F K H< 70, GGI GHH 61P90% ECE K H << G AD
KH< HM GMHG K< G > 90% G<I GGI.
IG H H < - KH< GSH M HM GG
(CAD)
.
! = !< G = HG, G <M (HH <GH > 6.47 /H).
= K G = H<G H<.
< '- <GH ' IG GH KH< GMHG - <GH
, K< KI H JGHH GH IHM.
H:H:
<G GIHG M H JGHH CAD M IHG.
" H< GH EC - <G * KJG, H< < CAD G << <
H< H.
AH M DB, <K , &CHG CB H . (1993) I H< <GHM <MG
HM HHG H G G M HM GG. AG "H &
118(2): 81P90.
GG GIG G G G H< GHG H< <GHM G HG, LI GG GH H< G - (G H 1.3.3.1). H<
HIG K<< GG GH IM K< H< <GH G:
HIIG JM //
IH H HJHM //
I<H M H< //
Chest pain of recent onset (CG95)
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GGH KH< GMHG GI< G NNGG, HHG, H SIHM
GKK.
CG IGG <GH H< H< (GI< G GHHGH
IGIGH ).
" KH<IH S CAD, K< GH H G LI
G GGGGH , GHH H< < CAD (G H 1). H<
GGGGH H< GH 12- EC H IH K< H< GHH.
A IH< GH HGH G KG:
" H< GHH < CAD G 61P90%, JGJ M <M G
H< SGH- GH JGHH H (G HG 1.3.4.4
1.3.4.5).
" H< GHH < CAD G 30P60%, IH G H< SGH-
GH JGHH (G H 1.3.4.6).
" H< GHH < CAD G 10P29%, C I G G H< SGH-
GH JGHH (G H 1.3.4.7).
D H IG LG EC H G LI GH KH<IH K CAD.
Chest pain of recent onset (CG95)
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11 II
< K I G G H< GH J J. < I I JG HG
H< H<G H< J IG H J H< I.
1.1 P'$+idi#g i#f$'"a)i$# f$' %e$%!e ,i)h che() %ai#
1.1.1.1 DGIGG M G ( K< H H< M /
JH) M <J, I LHM K< H< IG H< <GH G
IK. CH M GH.
1.1.1.2 LH H< GG IGG H< GMHG
H< IHHG.
1.1.1.3 CM L H< HG H H JM GH JGHH. & H
GG KH< H< H IH H< G:
EI H G IGHG.
J H HIHG GIGG.
EL HGH GIHG H< M IH< JGHHG.
1.1.1.4 J H IH M G JGHHG IG JMM, -
I. "I:
H< IG, SHG M HHG H< GH IM
IH
J GH JGJGG
G JG JHG.
1.1.1.5 H IH H< GG GH HGH, I M H
LGI.
1.1.1.6 AGG M <MG SIHG, G<H < G
SIHG KH< G EG<, K<< M H 'G
IGH H< H .
Chest pain of recent onset (CG95)
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1.1.1.7 H H GG G H< JH GG
H IG1
.
1.1.1.8 EL H< <GH G - IH< JGHH
H.
1.1.1.9 J JI J H IH G < H<M <J
IH< <GH .
1.2 Pe$%!e %'e(e#)i#g ,i)h ac*)e che() %ai#
<G GH H< I JG H< GGGGH GG KH< H IH <GH
GH, GIGH H IG M IH M GM (AC). < H ACJG HG I IGH , -GH-JH M H
(E&") --GH-JH M H (E&").
< I GGG GGGGH GG GHJ GHH, IG GH
H KMG. G H H<H GH E&" ("CE I 94) JG
H< M H H<G HG S GG <G
G< <GH.
1.2.11.2.1 "H GGGGH "H GGGGH H <GH H <GH
1.2.1.1 C< HM K<H< IHM <J <GH . " H<M
, < K< H< GH G KG, HIM H<M <J <
H< GH 12 <IG.
1.2.1.2 DH K<H< H< <GH M H< K<H< H<G
I G JH, M G:
H< <GHM H< <GH
H< G JGI G HG
<GHM G< <H GG M JIG HHH
JIG JGHHG <GH .
1.2.1.3 "HM GGGG M H< K GMHG, K<< M H AC:
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H< <GH / H< G ( L, H< G, K) GH
H< 15 IHG
<GH GGH KH< IG JH, GKH, H<GGGG,
HIM H H<G
<GH GGH KH< <M GHHM
K GH <GH , IH HH JIGM GH , KH<
IH <GH I IHM KH< HH LH, KH<
GG H GH H< 15 IHG.
1.2.1.4 D H IG 'G GG H MM HHH () H GG.
1.2.1.5 D H GGGG GMHG AC HM K. H
KH< AC GH KH< H <GH G H< H HI.
1.2.1.6 D H GGGG GMHG AC HM H< IG. <
G GMHG AC H H< IG.
1.2.1.7 + H <GH G M AC G GIGH (G
H 1.2.1.3) :
H<M IHM <J <GH
H<M IHM , IH < <GH H< GH 12 <IG, GH
12- EC G H J.
1.2.1.8 " AC G GIGH (G H 1.2.1.3) H< GG
M , IH G-M GGGGH :
H<M < <GH H< GH 12 <IG, IH K KH< GH
12- EC
H< GH G KG 12P72 <IG .
1.2.1.9 + GGGGH <GH AC G GIGH (G
H 1.2.1.3) :
H< <G GJ
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H< GG HG GI< G IM .
G IH H K<H< G<I G M IH
G-M GGGGH.
1.2.1.10 " H AC G GIGH K<G GH G <GH KG H< 72 <IG K< <J HG GI< G IM :
M IH H GGGGH (G HG 1.2.4.2 1.2.4.3)
S H< GG M GH 12- EC H J
H H IH H< H< H G H< GIGH AC K< HH H<
H J.
G IH H K<H< G GGM <K IH H<G
G<I .
1.2.1.11 + H <GH G M H<M <J H (S
GIGH) AC J IH< <GH .
1.2.1.12 < AC G GIGH, GHH H HM H<
H H H< IGHG (G GH 1.2.3) H GH 12-
EC (G GH 1.2.2). H< EC G G G GG, IH H M
HG H <GH.
1.2.1.13 " AC G H GIGH, G H< IGG H< <GH , G
K<< M -H<H (G HG 1.2.6.5, 1.2.6.6
1.2.6.7).
1.2.21.2.2 +GH 12- EC+GH 12- EC
1.2.2.1 GH 12- EC G G G GG. < , G
H< GIHG H <GH H<M J GG. + G H<
EC G<I H M HG H <GH.
1.2.2.2 FK HG KH< GH 12- EC G<K
-GH JH GI K H I < (BBB)
GGHH KH< IH E&" IH S GG G . CHI H
H (G H 1.2.3.4).
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1.2.2.3 FK GH E&" ("CE I 94) KH<
GH 12- EC G<K -GH GG KJ
JG GIGHJ E&" IGH IH S GG G
. CHI H H (G H 1.2.3.4).
1.2.2.4 EJ H< G -GH <G, <J G GIG
AC H< H< <G H< GH 12- EC, GSM * KJG
KJ <G. CG K GH E&" ("CE
I 94) H<G HG M. CHI H H (G
H 1.2.3.4).
1.2.2.5 D H LI AC K< <J GH 12- EC.
1.2.2.6 " GG AC G IH, G:
H G GH 12- ECG
JK JIG GH 12- ECG
H EC G.
G IH H <K H H<G G<I . H H<H H< GIHG
M H IGJ.
1.2.2.7 H JK GH 12- ECG M <H< GG IS
H HH H< G K G H H IH IHH HHH.
1.2.2.8 " GGGGH (G G H 1.2.1.10) GH
12- EC GG AC GG M, G H< IH
HG. FGH G H<G H<H -H<H GI< G IM
G, H GGH I. CHI H H (G
H 1.2.3.4).
1.2.31.2.3 "H H GIGH IH M GM"H H GIGH IH M GM
&H AC G<I GHH G G G H G GIGH, IH G<I H M HG H
<GH. < HG H<G GH G<I IH H< H H H<
IGHG.
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1.2.3.1 G G G GG. <G M <J KH< (GII
I), IH HJIG G GI< G <, HIM
IH M H (&") G GIGH.
1.2.3.2 G G 300 G G G G GG IGG
H< G J H<H H<M H H.
" G G J J H <GH, G KHH H<H H <G
J KH< H< G.
M H< HHH HG <GH. FK H I
(GH E&" "CE I 94 HG
E&").
1.2.3.3 D H IHM GH LM, IH H LM GHIH IG IG
LHM G G G GG, M <GH GG. M
GIH LM H:
KH< LM GHIH (2) GG H< 94% K< H H G
<M GHM I, 2 94P98%
KH< < GHIHJ IM GG K< H G <M
GHM I, H <J HH 2 88P92% IH G MGG G
J.
1.2.3.4 &H KH< IH <GH , IG IH H <K
H H<G G<I , IH S GG G . <G G<I I:
LHG / H< GMHG
IG GGI
<H <MH<
LM GHIH M IG LHM
H GH 12- ECG
< G HJ.
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1.2.3.5 & H< H<IH HJHG IG H I (GH
E&" "CE I 94 HG E&").
1.2.41.2.4 AGGGGH <GH KH< GIGH IH M GMAGGGGH <GH KH< GIGH IH M GM
1.2.4.1 GH 12- EC G H " GIH
(G GH 1.2.5) J <GH.
1.2.4.2 CM IH <MG LH H H:
<M GHHIG
GG HG, L IM , G<
GG -M IGG IH <GH , GI< G H GGH.
1.2.4.3 H <GHM IGG E&" G S H< GH
12- EC (H<H G, -GH JH GI K BBB).
+:
H< <HGHG H<
H< GGH GMHG
M <GHM JGI GG
M JGI G HG
HG JIG JGHHG HHHG G GMHG <GH .
1.2.51.2.5 G < G < G GG IH M GMG GG IH M GM
1.2.5.1 G H " GIH H GGGGH
<GH. <G H< < G H G IH &".
1.2.5.2 G G H " GIH
10P12 <IG H H< GH GMHG.
1.2.5.3 D H IG < G GI< G HIH HG << GGHJHM
C-HJ H H G AC.
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1.2.5.4 D H IG < G M G< (GI< G G<-
S I) G G H G GG K< GGGG
KH< IH <GH .
1.2.5.5 H IH H< GHH, H< H GH GMHG
H< GH 12- EC SG K< HH H
GIHG.
1.2.61.2.6 & GG& GG
1.2.6.1 < G &", IG H< IJG SH M H2
. <G
G H< HH G / G (M H)
KH< H GH JI J H< 99H< H H< I H,HH< KH< J M G< KH< H GH H<
K:
GMHG G<
EC <G HJ K G< (K - <G K BBB)
JH H< * KJ <G H< EC
J K GG J MI K K H
HM3
.
< GGSH &" IG:
M 1: GHIG &" H H G< I H M M JH GI< G
I G / IHI, SGGI GGH.
M 2: &" GM H G< I H H< G LM
G GIM, GI< G M GG, M G, , <MH<G,
<MHG, <MHG.
1.2.6.2 < G H J G HH KH< GIGH AC,
GGGG H LI H< IGG G H ( L, MHG,
H GGH IM G) S H< GG
AC.
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1.2.6.3 < G H J G HH KH< GIGH AC, K
H< H I (GH E&" "CE I
94 HG E&") IH S GG G . CHI H
H (G H 1.2.3.4).
1.2.6.4 < GG AC G S, K H< H I
(GH E&" "CE I 94 HG
E&").
1.2.6.5 +GGGG KH< <GH KH<IH G H JG (H
HM H GG) IH GH 12- EC <G H
H K<H< H< <GH G M H .
" M G< G GIGH, K H< HG GH
<GH H<G I (G GH 1.3). G IH H
H< H M IH< GH JGHHG.
1.2.6.6 CG <GH -M H < LI HG AC GI< G IM
, H< GG GI< G IH<L I.
1.2.6.7 M G M <GH IH H<M (C) H I IH H<GG GI< G IM G H GGH, H H G
AC.
1.2.6.8 " AC <G LI H M H H< H<KM, IH <J
G HG JGI GG, K H< H I,
L SH ("CE I 67), !MHG ("CE
I 34; M "CE I 127).
1.3 Pe$%!e %'e(e#)i#g ,i)h ()ab!e che() %ai#
<G GH H< I GGG H< GGGGH GG HHHH GH <GH
KH< GIGH GH .
A G IGIM IG M M HM GG (CAD). & GG GH
IG M CAD KH< <GH G H KMG GH<HK, H< HG
H I GIH IH. C GGGGH M GISH H S
LI GG GH , IH K< H< G IHHM, H GH HGH
Chest pain of recent onset (CG95)
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(IH H HGH) I M H< GHHG < M HM GG
H 1 G I.
1.3.1.1 DG GH G H< K:
GGGGH
GGGGH IG GH HGH (H<H G, H HGH GHIHJ
CAD / IH HGH M G<).
1.3.21.3.2 C GGGGHC GGGGH
1.3.2.1 H <GHM IH:
H< GL H< G
H< <HGHG H< , I HG H, H, GJHM, IH
IM, HG H<H J J H<
M GGH GMHG, GI< G H<GGGG
M <GHM , &", M JGIGH, H< JGI GG
M JGI G HG.
1.3.2.2 CM IH <MG LH H:
HM G HG JGI GG
HM GG H< JGI GG
HM -M IGG ( L, GJ H GHGG,
MH<M)
LI H< IGG <GH .
1.3.31.3.3 & GG G GGGGH& GG G GGGGH
1.3.3.1 A G:
GHH GH H< H H< <GH, H< , G<IG, K, G
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HH M <MG LH
J M GH KH< IH 5 IHG.
G GGGGH H< HMHM HIG GH K HGHH H< < CAD (G H 1):
< H< HIG J S G HM .
K H< H< HIG J S G HM .
H< HIG J S G - <GH .
1 1 H GHH H <H GHH H <JJ M HM GG H HMHM M HM GG H HMHM
GMHG, , GGMHG, , GL G HGL G HG
- <GH - <GH AHM AHM M M
& & &
A (MG) ! ! ! ! ! !
35 3 35 1 19 8 59 2 39 30 88 10 78
45 9 47 2 22 21 70 5 43 51 92 20 79
55 23 59 4 25 45 79 10 47 80 95 38 82
65 49 69 9 29 71 86 20 51 93 97 56 84
F H< 70 KH< HM HM GMHG, GGI GHH > 90%.
F K H< 70, GGI GHH 61P90% ECE K H << G AD
KH< HM GMHG K< G > 90% G<I GGI.
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IG H H < - KH< GSH M HM GG
(CAD)
.
! = !< G = HG, G <M (HH <GH > 6.47 /H).
= K G = H<G H<.
< '- <GH ' IG GH KH< GMHG - <GH
, K< KI H JGHH GH IHM.
H:
<G GIHG M H JGHH CAD M IHG.
" H< GH EC - <G * KJG, H< < CAD G << <
H< H.
AH M DB, <K , &CHG CB H . (1993) I H< <GHM <MG HM HHG H G G M HM GG. AG "H &
118(2): 81P90.
1.3.3.2 D H S HM HM HIG <GH -
<GH HM K.
1.3.3.3 D H S HM HM HIG <GH -
<GH HM H< IG.
1.3.3.4 H< K HG, K<< GG GH M,
H IH K< GHH 'G < :
G
K<H< H< G G
JGI G HG I:
<GHM G
HG
<MHG
MG
M <GHM HI CAD
Chest pain of recent onset (CG95)
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H< JGI GG
<GHM GHG< CAD, L, JIG &", M JGIGH.
1.3.3.5 " <J HIG HM G GGGGH H<
GHH < CAD G H H< 90% (G H 1), IH< GH
JGHH G IGGM. & G .
1.3.3.6 GG GIG G G G H< GHG H< <GHM G
HG, LI GG GH H< G - (G
H 1.3.3.1). H< HIG K<< GG GH
IM K< H< <GH G:
HIIG JM //
IH H HJHM //
I<H M H< //
GGH KH< GMHG GI< G NNGG, HHG, H SIHM
GKK.
CG IGG <GH H< H< (GI< G GHHGH
IGIGH ).
1.3.3.7 " H< GHH < CAD G GG H< 10% (G H 1), SGH G
IGG <GH H< H< IG M CAD.
1.3.3.8 CG JGHH H< IGG , GI< G <MH<
MH<M, KH< HM - <GH K
< CAD (GHH H GG H< 10%).
1.3.3.9 A HGHG H HM HG K<< LH , GI< G
, JGHH GH .
1.3.3.10 M G <GH -M H< GG, GI< G I HII,
GIGH.
1.3.3.11 " GG GH <G LI H M H H<
H<KM, IH <J G HG JGI GG, K H<
Chest pain of recent onset (CG95)
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H I, L SH ("CE I
67), !MHG ("CE I 34; M "CE
I 127).
1.3.3.12 F K< GH H G LI H< GG
H< GGGGH , H GH 12- EC G G G GG
H GHH.
1.3.3.13 D H I IH GG GH H< GG GH
12- EC.
1.3.3.14 A I <G GH 12- EC GGHH KH< CAD
M H G< JIG H. <G I:
H< * KJG HI
BBB
-GH KJ HG ( L, THH JG).
H H<H H< GIHG M H IGJ.
CG M GH 12- EC <G HH< KH< 'G <GHM
G HG.
1.3.3.15 F KH< S CAD ( L, JIG &", JGIGH,
JIG <M) K< GH H G LI
G GGGGH , G H 1.3.4.8 IH
IH HGH.
1.3.3.16 " KH<IH S CAD, K< GH H G
LI G GGGGH , GHH H< < CAD
(G H 1). H< GGGGH H< GH 12- EC H
IH K< H< GHH. A IH< GH HGH G
KG:
" H< GHH < CAD G 61P90%, JGJ M <M G
H< SGH- GH JGHH H (G HG 1.3.4.4
1.3.4.5).
Chest pain of recent onset (CG95)
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" H< GHH < CAD G 30P60%, IH G H< SGH-
GH JGHH (G H 1.3.4.6).
" H< GHH < CAD G 10P29%, C I G G H< SGH-
GH JGHH (G H 1.3.4.7).
1.3.3.17 CG G M H< G'G <GH G M H GH , IH
GG G . D H H G H< G J H<H
M H G IM H H.
1.3.3.18 FK HG GH 4
K< KH H< GIHG
JGHHG GMHG HM GH .
1.3.41.3.4 DGH HGH K< GH H G DGH HGH K< GH H G
LLI I M GGGGH M GGGGH
<G I GGG M H< GH JI HGHG GH . < GH JI
H<G HGHG KG H G.
< I DJH I IM G H< G H LGI
GH HGHG. "H GIGG H<H H< G G H G H< HLH H
LGI JMM , H< GIGHH HG G H<H G K J IH< H H< HH G H HH GG HI HGH G
H . < M H GHH H< H H G M
KH< 10 GJHG H G 1 20005
.
< I DJH I <GG H<H H< HG H<G I H
GG <GH , H H G CAD. &GH G KH< -
<GH H GGGGH IH< GH HGH. !KJ JM G
I , H< G H<H H< I G<, K<< G H<
G IG IHK<G H< G M HH H LGI.
1.3.4.1 "I H< HMHM HIG H< GHH CAD
< (G H 1.3.3.16) IGHG GH
JGHHG H< G'G HG.
1.3.4.2 G IH H H IH 'G G
HG K< G GH HGH.
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1.3.4.3 H IH 'G G H LGI K< G K<<
GH HGH H IG.
1.3.4.4 F KH< <GH K< GH H G
LI M GGGGH K< <J GHH <
CAD 61P90% (G H 1.3.3.16), JGJ M
<M H GGGGH GH 12- EC :
M JGIGH G G
JGJ M <M G M H H H H< G.
1.3.4.5 F KH< <GH K< GH H G
LI M GGGGH K< <J GHH <
CAD 61P90% (G H 1.3.3.16), -JGJ IH
H GGGGH GH 12- EC :
M JGIGH G H G
JGJ M <M G H M H H H H< G.
1.3.4.6 F KH< <GH K< GH H G
LI M GGGGH K< <J GHH <
CAD 30P60% (G H 1.3.3.16), -JGJ IH
M G<. GH 1.3.6 IH< I -
JGJ IH HGH.
1.3.4.7 F KH< <GH K< GH H G
LI M GGGGH K< <J GHH <
CAD 10P29% (G H 1.3.3.16) C I G. " H<
I G G:
N, G H< IGG <GH
1P400, 64-G ( J) C M <M
H H< 400, JGJ M <M. " H<G G H M
H H H H< G JGIGH G H G,
-JGJ IH . GH 1.3.6 IH< I -
JGJ IH HGH.
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1.3.4.8 F KH< S CAD ( L, JIG &", JGIGH,
JIG <M), -JGJ IH HGH K< H< G
IHHM IH K<H< <GH G IG M M G<.
GH 1.3.6 IH< I -JGJ IH HGH. A
LG EC M IG GH IH .
1.3.51.3.5 AH GH AH GH JJGHHGGHHG
1.3.5.1 -JGJ IH (G GH 1.3.6) M
G< JGJ M <M 64-G ( J) C M
<M <G G<K CAD IH IH GS.
1.3.5.2 JGJ M <M G G- JGHH K< H<GIHG -JGJ IH IGJ.
1.3.61.3.6 G -G -JGJJGJ IH HGH IH HGH MM G< G<
1.3.6.1 < -JGJ IH M G< IG:
M IG GH<M KH< G <H GG IH H<M
(& KH< EC)
GHGG <<M
SGH-GG HGH-< H G (&+) IG
&+ GHGG-I K H HG.
IH M J H<M LHG, H< G H<
G, M HHG K< H< H<. <G
H IHG G H 1.1 &M IGGH<M H< GG H M H
("CE H<M G I 73).
1.3.6.2 G G, M IH G GHGG HG & KH<
EC G M SGH-GG HGH-< &+
IG.
1.3.6.3 G LG IH GHGG <<M &+
GHGG-I K H HG.
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1.3.6.4 D H IG &+ M <M G GH .
1.3.6.5 D H IG LG EC H G LI GH
KH<IH K CAD.
1.3.71.3.7 & GG K & GG K JJGHHGGHHG
BBL 1 DSH GSH M HM GGL 1 DSH GSH M HM GG
SH M HM GG (CAD) I I JGJ M <M
G R 70% H GHGG H GH HM GH R 50% H
GHGG H< H M HM:
FHG HGM G<.
I< HG K GG GJ GG ( L R 50%) H I :
+I LM JM: , M GG.
"G LM : H<M, H JHI <MH<M.
GG G< MI: LM H GG.
G H<.
FHG I G<.
I< HG M GJ GG (R 70%) GMHH:
-J H GIM.
GG G< MI: GHM H GG, H H< HHM
M GIM.
1.3.7.1 CS GG GH K IG 4
K<:
GSH CAD (G L 1) G I I JGJ 64-G ( J) C M
<M //
JG M G< G I I -JGJ IH .
1.3.7.2"JGHH H< IGG <GH K<:
Chest pain of recent onset (CG95)
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GSH CAD (G L 1) G H I I JGJ M <M
64-G ( J) C M <M //
JG M G< G H I I -JGJ IH
H< I G G N.
1.3.7.3 CG JGHH H< IGG , GI< G <MH<
MH<M GM , KH< HM - <GH
JGHH LIG TK-H GG H< M HG.
1F L, GH E&" ("CE I 94), ALHM ("CE
I 113) DMGG ("CE I 17).
2<MG $, AH #, <H !D H . < H< H EC/ACCF/A!A/!F G F
H< SH M H (2007). JG SH M H.
#I H< A C CM 50: 2173P95.
3< I DJH I H JK H< J H< IG J
K GG J MI K K H HM H< GG &", IH
G H<H H KG I G H H< IJG SH &". < I
DJH I G H<H H I IG, IH KI H IHM K< H<
K GMHG G< EC <G.
4H . "CE I 126 (2011).
5 C H . (2009) "N H : G JGM H<
A !H AGGH CHH C " H< CI C CM
CHH CJGI " "HJH H< CI CJGI
+M "HJH. CIH 119(7): 1056P65.
Chest pain of recent onset (CG95)
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22 HG H< G H< IHG H< G H< I
"CE IG J KH< G H<H SG K<H H< I K
K H J.
< I JG IHG K< <J H GH <GH GH GIGH
, KH< KH<IH <GHM / GG JGI GG. "H IG H<G
GH KH< H< IH GH <GH .
< I GGG GGGGH JGHH GHJ GHH I:
GGGGH H H GHH
M, H < HJHG GI< G LM, HHH H<M
IG G K
< H JGHHG
IH H JG, HI JJ HHG GG
K< JH K< GGH KH< <GH GH, H< G G
H IG G.
< I G H J H< H, I GH JGHHG, GMH
H H< IG <GH GH G K. "H G H GG -G<
<GH ( L, HIH <GH IM) K<< G K H H H H<
H, K< H< GMHG.
!K H<G I KG !K H<G I KG JJ
"CE GG H< H CH CH AIH CHG (K H< HC I CH AIH C< CHG) H J H<G I. < CH
GHG< I DJH I (G L A), K<< JK H< J
J H< HG. A H I +JK JGK H<
JH H< I (G L B).
< G H IH <K "CE IG J H< "CE KGH,
!K "CE IG J: JJK GH<G, H< I H<
!.
Chest pain of recent onset (CG95)
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33 "HH"HH
"CE <G J HG H < GHG H H<G I.
Chest pain of recent onset (CG95)
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44 +G< HG+G< HG
< I DJH I <G H< K HG G<, G
HG JK J, H J "CE I HH H< IHI. < I
DJH I'G I GH G< HG G H H< I I (G
GH 5).
AIH <GH AIH <GH
4.1 C$()-effec)i+e#e(( $f "*!)i(!ice CT c$'$#a' a#gi$g'a%h f$' '*!i#g $*)
$b()'*c)i+e CAD i# %e$%!e ,i)h )'$%$#i#-#ega)i+e ac*)e c$'$#a' (#d'$"e(
Re(ea'ch &*e()i$#
"G IHG C M <M GH-HJ SGH- HGH I IH GHIHJ CAD
KH< GIGH H-HJ IH M GMG?
Re(ea'ch 'ec$""e#da)i$#
"JGHH H< GH-HJGG IHG C M <M G SGH- HGH
I IH GHIHJ CAD KH< GIGH H-HJ IH M GMG.
<<M H<G G HHM H<G G HH
CIH EI HM CM IG GHH H<H H-HJ AC, KH< -
GH < H< EC, ' GHGG HGH G Q HHG KH< GSH G<
I H< GHGG HGH, M <M GIGIH JGIGH G<I
G'. H GHGG HGH <G HJM K GGHJHM GSHM G CAD
H<G I . < GSH H H-G GG K< H<GKH< M HG GIH H IGGM JGJ M .
&IHG C M <M G <<M GGHJ JG HHM IGI G
M I-IH CAD H-HJ IH M GG. H K K<H< H G
GH HJ KH< LG EC G SGH HGH H< GH K I H<G I.
4.2 N$+e! ca'diac bi$"a'e'( i# %e$%!e ,i)h ac*)e che() %ai#
Re(ea'ch &*e()i$#
Chest pain of recent onset (CG95)
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<H G H< HJGG GH HJGG K, <<-GGHJHM H GGM H<G
H< K G K, I, << G KH< IH <GH ?
Re(ea'ch 'ec$""e#da)i$#
EJIH K, <<-GGHJHM H GGM H<G K, I << G IG
KH< IH <GH .
EJIH H< IHHJ G KH< H< GH GH
H< GH M HJ GH-HJ H GGMG.
<<M H<G G HHM H<G G HH
K GGHJ H GGMG M JHG J JIG GGMG HG
GH IM. <M M K LIG M H H< H< 12 <I
H IHM I. H< G G H H H< GH
J H GGMG.
4.3 Re/#i#g )he *(e $f )e!e%h$#e ad+ice i# %e$%!e ,i)h che() %ai#
Re(ea'ch &*e()i$#
" K<H IGHG G<I H< J J H KH< <GH ? "G H<
HGG TI M , GL GMHG?
Re(ea'ch 'ec$""e#da)i$#
J IGH GMGH J H H< J H KH< <GH .
<<M H<G G HHM H<G G HH
< H< G H< SGH HH KH< <H< GJG, IG
I M GG H <GH GMHG. I< GG <G G ,
G <I GHG. +G< G<I IH H M M GG
IGHG G H, H< HS HG GI< G , GL, GGH
GMHG H<H KI K S GG H IG GIG.
H <GH H <GH
Chest pain of recent onset (CG95)
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4.4 E()ab!i(hi#g a #a)i$#a! 'egi()' f$' %e$%!e ,h$ a'e *#de'g$i#g i#i)ia!
a((e(("e#) f$' ()ab!e a#gi#a
Re(ea'ch &*e()i$# a#d 'ec$""e#da)i$#(
C H GHM GH KH< GIGH GHG< H K <H
MGG HHHG, JGHHG IHG H<G I? I< GHM KI J
JH GI HH G< HG, I:
JH JH K G GGGG H< GHH < GG,
GG IHGH IHHG H< GHH H< < CAD G
G GIG H H GGGGH (<GHM, LH, IH G, GH
12- EC)
GGGGH H< LHH H K<< K IH G H H H
GIG H H GGGGH
JG K H IHH KH<IH GSH K-I G K
JIH H< GH GH HGH C-G, &+,
<<M, I H<G.
<<M H<G G HHM H<G G HH
A H GHJ GHM GIHJ KH< GIGH GH H
GH HGH G H IHM LGH H< $ M H< IHM. EGHG< GI<
GHM KI H< K H< GHH<G: GHHGH GN, GHHJ
HHG KH<IH K-I G, HM H. <G KI J M G I<
H< LGH J G.
AIH GGGGH H< < M GG G H H< GH-HJ< JGHHJ H<G GI< G C M I G KH< <GH
H<H M IG M M G<. < H K<< H< GHH < CAD G
G H 1979 IH M H H HM $
IHG. < HI IHHG IH H< H GGGGH KH<
GIGH GH . F L, H< GG HIHG G GIG GI< G
M GG L, IH G ( L, <) J IH G
H GHHG H< < CAD H K I IH< GGGGH H< K<
IH S GIIG I H< HG.
Chest pain of recent onset (CG95)
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4.5 C$()-effec)i+e#e(( $f "*!)i(!ice CT c$'$#a' a#gi$g'a%h c$"%a'ed ,i)h
f*#c)i$#a! )e()i#g i# )he diag#$(i( $f a#gi#a
Re(ea'ch &*e()i$#
<H G H< GH HJGG IHG C M <M KH<
IH HGH H< GG IH KH< GH <GH K<
<J H (30P60%) < CAD?
Re(ea'ch 'ec$""e#da)i$#
FIH< G< G<I IH H JIH H< GH HJGG IHG
C M <M KH< IH HGH H< GG
IH KH< GH <GH K< <J H (30P60%) < CAD.
<<M H<G G HHM H<G G HH
&IHG C M <M <G J M H MG. IG< JKG <J
G<K H H <<M HJ H< GG HM GSH CAD, GH H
H H<H HGHG I H HJM K GH. !KJ, IGHG IH H< HM
IHG C M <M H IHM HM GHGG IH GS(H<H G, H<G H<H GISH H IG ) KH< GH <GH . <G G GM
HI KH< H < GSH CAD.
CGH-HJGG H H <G IG H< GG CAD G G<H-H IH,
G GI< LGJ H HGHG IHG C M <M HH H<
IH HGH GHHG GI< G & KH< EC, GHGG IG &+ GHGG
<<M. BIG H< GG G H< HI IH HGH, <H<
G H JIH GH H<G H< HM H G GH .
4.6 I#f$'"a)i$# ab$*) %'e(e#)i#g a#d e%!ai#i#g )e()(
Re(ea'ch &*e()i$#
A GH KH< <GH K H K<H< H H H< GH
H<KMG . !K G<I H IH H< GH H<KM H< M IHG,
GG SHG, KH< KH<IH HHH, GH HJM GH H HI IG
, S M , H<HM GL?
Chest pain of recent onset (CG95)
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Re(ea'ch 'ec$""e#da)i$#
GHG< H< GH KMG GH H IH H< GH H<KM H KH<
<GH .
<<M H<G G HHM H<G G HH
&H<G IH (H< H< HH JM) K I M IH J-
G GH H. CH HG G<I IH G K-GHIH G
H HG H< HG H H<G IH H<
IGH H< G KH< <GH . I< GHIG <H G I JM
<GG, I J GIGG KH< GGH IG G K G GS
H THG JGI H.
AM HG G<I G JGHH H< GHM HI GIGH I H H
IG KH< GH KH< <GH K< KH< HG H<
H<KM.
M M M L H< GIGG H< G GH H<KMG H<
<H< GG GM H H<H GH <G H H<H
HH'G , H< GHI G, LHHG, M GHG IH H<H, <J H H IH. CGH G<I J H M IH
G H< G M <J.
Chest pain of recent onset (CG95)
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55 H< JH< JGG H<G IGG H<G I
5.1 F*!! g*ide!i#e
< I I, C<GH H GH: GGGGH GG H GH <GH
GH GIGH , HG HG H< H<G J IG H
J H< I. "H G IG< M H< H C I CH AIH
C< CHG.
5.2 I#f$'"a)i$# f$' )he %*b!ic
"CE <G I H H< I L H<G I.
I ! JIHM GH GHG H IG HLH H<G H H<
K HG IH <GH GH H GH.
Chest pain of recent onset (CG95)
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66 +H "CE I+H "CE I
IG<IG<
JH JGI GG. "CE I <H< I 25 (2010).
GH E&". "CE I 94 (2010).
SH. "CE I 67 (2008).
&": GM JH. "CE I 48 (2007).
!MHG. "CE I 34 (2006). (+ M "CE I 127)
HHG H< JH JGI JHG. "CE H<M G I 94
(2006).
ALHM (). "CE I 22 (2007). (+ M "CE I
113)
DMGG (). "CE I 17 (2005).
&M IG GH<M H< GG H M
H. "CE H<M G I 73 (2003).
H . "CE I 126 (2011).
Chest pain of recent onset (CG95)
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77 H H< IH H< I
"CE IG IH G H<H HG H H IH HH K
H. K J G < 3 MG H IH, <H< GGG
HHG G H< JKG; K IG H<G H H K<H< H
I G IH. " HH K J G IG< H H< HG, K M H
IH G HG.
Chest pain of recent onset (CG95)
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AL A: < I DAL A: < I DJJH I "CE H HH I "CE H H
G*ide!i#e De+e!$%"e#) G'$*%
GG A G (GG A G (C<)C<)
GG C CM, BHG H< , *I &M'G < &
DHGHM,
D # (D # (C AJG)C AJG)
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