3. / ST 150mg/dL 80mg/dL 110mg/Dl Level B Class I 1. / ST Level C 2. / ST Level C Class IIa 1. / ST Level C 2. / ST, Level C Class I 1. / ST Level A 2

2007 ACC/AHA: / ST Part VI-IV 6. Class I 1. / ST Level B 2. / ST Level B 3. Level B 4. Level B Class I 1. / ST Level A 2. / ST 110mg/dL 180mg/dL HbA1c 7% Level B 3. / ST GP IIb/IIIa I.C.3.A IV.B Level A ( Level B ) Class IIa 1. / ST Level B 2. / ST Level B 2 97 2

3. / ST 150mg/dL 80mg/dL 110mg/Dl Level B Class I 1. / ST Level C 2. / ST Level C Class IIa 1. / ST Level C 2. / ST, Level C Class I 1. / ST Level A 2. / ST Level B 3. / ST / Level B 4. / ST Level B 5. / ST Level C 3

Class I 1. / ST Level B 2. Level A Class I 1. ST Level C 2. NTG ST Level C 3. NTG ST Level C Class IIa 1. ST NTG Level C 2. ST T NTG Level C 3. / ST Level C Class III ST T Level C VARIANT (PRINZMETAL S) AN- GINA Class I 1. ST Level A 2. ST Level B 3. Level B Class III 4 97 2

Level B CARDIOVASCULAR SYNDROME X" Class I 1. beta blockers X Level B 2. X Level B ST STEMI ST NSTEMI UA ACS ST " " ACS http://www. nhlbi.nih.gov/actintime/index.htm. 12 STEMI ACC/AHA ACC/AHA Class III beta blockers Level C / ST acute coronary syndrome, ACS ACS / ST, / ST T Troponin ST " " Guidelines for the Management of Patients With ST Elevation Myocardial Infarction ST troponin I, troponin T, CK-MB ST ST 5

/ ST microembolization / PCI ACS 3 1. 2. 2 3. Canadian cardiovascular society classification ST / ST / ST 1. / ST / ST 2 2. 1/3 6 97 2

/ / ST III. EMS ACS "Act in Time" (www. nhlbi.nih.gov/health/public/heart/ mi / core _ bk. pdf) ACS 2 ACS ACS 119 EMS EMS ACS 1 10 STEMI EMS NTG ACS 2 5 NTG 3 aspirin 162 325 1. ACS 20 syncope/presyncope 20 30 2 ACS 7

1. The initial medical history, physical examination, ECG, assessment of renal function, and cardiac biomarker measurements in patients with symptoms suggestive of ACS can be integrated into an estimation of the risk of death and nonfata cardiac events Table 3 ACS 3 TIMI GRACE, and PURSUIT III.B 2. 5 (1) (2) (3) (4) (5) UA/ NSTEMI UA ACS NTG Section VII:.A VII.D ACS 3. TIMI 7 1 4 UA/NSTEMI www.timi.org 30 1 PURSUIT trial 8 97 2

GRACE 6 9 3 GRACE www.outcomes-umassmed UA/NSTEMI ( LMWH), GP IIb/IIIa 4. 12 ACS 1 ST 0.05 mv [ 0.5 ] ST UA NSTEMI T 2 [0.2 mv ] UA/ NSTEMI Q ACS 1% 6% NSTEMI 4% UA 4% ST V7 V9 ST STEMI ST 12 5. ACS NSTEMI STEMI 6. ACS 3/4 9

UA 7.,?, cardiac troponins cardiac troponins - ST and T-, - - Q - - A. CREATINE KINASE-MB (CK-MB) CK-MB troponins A. Troponins Troponins T I ctn " T I T I T I T I B. ( Myoglobin) Heme 2 ST troponins C. troponins 2~4 8~12 CK-MB 5 ~14 10 97 2

4 30% to 40% ST CK-MB troponins ST Troponins 5 troponins ST Troponins vs. UFH GPIIb/IIIa clopidogrel troponins CK-MB troponins CK-MB troponins T I troponins T 6 2 8. B-type natriuretic peptide BNP pro-bnp ST / ST troponin I, CRP, BNP / ST A. 12 / ST ST 1. 1, B1. 1, C1. 1, B2 2002 ACC/AHA 11

.1,E1 12.1,B4 ST. 1,C3 Fig. 1, D3 2002 ACC/AHA ST.1, C2. 1,E1 Fig. 1, H3. 1, H1. 1, I1 1. ( ).1, H3 7 /. 1,D2, F2 Fig. 1, H3 Section IV. 1, F1. 1,G1? 72 72, 12 97 2

1 13

2 NTG (EMS) 14 97 2

3 15

4 4. 16 97 2

. (ULN;, < 10%) CK isoforms ( ). CKMB ( ) 2~5 2~3 ( ST ) 20~50 ( ST ) 7 42. I p < 0.001 5. 17