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Syndromes coronariens aigus : prise en charge thérapeutique en urgence

Acute coronary syndrome : therapeutic care in emergency

  • Mise Au Point / Update
  • Published:
Annales françaises de médecine d'urgence

Résumé

Le syndrome coronarien ou coronaire aigu (SCA) est constitué des manifestations cliniques, électrocardiographiques et biologiques liées à la rupture d’une plaque « vulnérable » d’athérome ayant induit la formation d’un thrombus limitant le flux sanguin dans le réseau artériel coronaire [1,2] Merci de replacer ces appels de référence dans le texte. Les SCA sont classés en SCA avec élévation (ou sus-décalage) du segment ST (SCA ST+) et en SCA sans élévation du segment ST (SCA non ST+). Dans les SCA ST +, le thrombus est constitué principalement de fibrine entraînant une occlusion coronaire aiguë totale responsable d’une nécrose complète du tissu myocardique dans les six heures, tandis que dans les SCA non ST+, il est plutôt de type plaquettaire n’obstruant pas complètement la lumière artérielle [3] Merci de replacer cet appel de référence dans le texte. La douleur thoracique est le signe d’appel le plus courant. Le facteur temps est l’élément clé dans la prise en charge des SCA. Le rôle des Samu-Smur-Centre 15 est essentiel, permettant une prise en charge rapide. Quel que soit le type de SCA, le traitement comporte la prise d’aspirine, de clopidogrel ou de prasugrel, d’anticoagulant, une anxiolyse (si besoin) et un traitement antalgique. Dans les SCA non ST +, l’évaluation des marqueurs biologiques de souffrance myocardique (troponine) peut permettre une orientation diagnostique et thérapeutique dès la phase préhospitalière. L’apport récent de nouvelles et puissantes molécules antiagrégantes plaquettaires et anticoagulantes a modifié les stratégies décisionnelles et de prise en charge des SCA en préhospitalier afin de garantir une reperfusion optimale et dans les meilleurs délais.

Abstract

Acute coronary syndrome (ACS) is defined a spectrum of clinical, electrical and biological manifestations due to the rupture of an unstable atheromatous plaque causing the development of a thrombus, which limits blood flow in the coronary circulation [1,2]. ACS is classified as ST-segment elevation ACS (STEMI) and non-ST-segment elevation ACS (NSTEMI). In STEMI, the thrombus is made of fibrin, which causes complete obstruction of the artery associated with total necrosis of myocardial tissue within 6 hours [3]. In NSTEMI, the thrombus is made of platelets, which causes incomplete obstruction of the artery. The commonest symptom is thoracic pain. Time is the major limiting factor in ACS management. The prehospital emergency department (SAMU) plays a fundamental role in ACS management in France. Whatever is the type of ACS, the treatment is based on aspirin, clopidogrel or prasugrel, anticoagulant, anxiolysis (if necessary) and analgesia. In NSTEMI, the level of risk for death and severe infarction is based, at least in part, on the measurement of troponin serum concentration in MICU AU: Please expand.. New antiplatelets and anticoagulant molecules have been recently developed to improve the prehospital management of ACS and to optimize and reduce time to artery reperfusion.

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Authors and Affiliations

  1. Unité commune de recherche du pôle de l’urgence, Samu régional de Lille, CHRU de Lille, 5, avenue Oscar-Lambret, F-59037, Lille cedex, France

    N. Assez, E. Wiel, C. Lemanski-Brulin, C. Adriansen & P. Goldstein

  2. Unité commune de recherche du pôle de l’urgence, laboratoire de pédagogie de la santé EA 3412, université Paris-XIII, CHRU de Lille, 74, rue Marcel-Cachin, F-93017, Bobigny, France

    N. Assez

  3. Unité commune de recherche du pôle de l’urgence, équipe d’accueil EA 2694, université Lille-II Nord de France, Lille cedex, France

    E. Wiel

  4. faculté de médecine Henri-Warembourg, CHRU de Lille, F-59045, Lille cedex, France

    E. Wiel

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  1. N. Assez
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Assez, N., Wiel, E., Lemanski-Brulin, C. et al. Syndromes coronariens aigus : prise en charge thérapeutique en urgence. Ann. Fr. Med. Urgence 1 (2011). https://doi.org/10.1007/s13341-011-0116-2

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  • DOI: https://doi.org/10.1007/s13341-011-0116-2

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