SÍNDROME CORONARIANA AGUDA: DIAGNÓSTICO PRECOCE E MANEJO TERAPÊUTICO NA EMERGÊNCIA
DOI:
https://doi.org/10.56238/levv17n57-046Palavras-chave:
Síndrome Coronariana Aguda, Diagnóstico Precoce, Medicina de Emergência, Infarto do Miocárdio, TerapêuticaResumo
As doenças cardiovasculares permanecem como a principal causa de morbimortalidade global, e a síndrome coronariana aguda (SCA) constitui um desafio central nos serviços de urgência e emergência. Esta revisão narrativa sintetiza evidências publicadas entre 2021 e 2025 sobre o diagnóstico precoce e o manejo da SCA no contexto emergencial. O diagnóstico contemporâneo baseia-se na integração entre avaliação clínica, eletrocardiograma de 12 derivações e biomarcadores cardíacos de alta sensibilidade, especialmente a troponina. A adoção de algoritmos diagnósticos acelerados (0/1 h e 0/2 h) aumentou a eficiência e a segurança do fluxo assistencial, permitindo a exclusão confiável de infarto agudo do miocárdio em pacientes de baixo risco, quando aplicada em consonância com o julgamento clínico. A estratificação de risco é aprimorada pelo uso de escores validados, destacando-se o HEART na predição de mortalidade em curto prazo e o T-MACS na identificação de pacientes com maior risco de eventos adversos cardiovasculares maiores. Na SCA sem supradesnivelamento persistente do segmento ST, o momento da cineangiocoronariografia é determinado pelo perfil de risco isquêmico, recomendando-se estratégia invasiva imediata para pacientes de muito alto risco e abordagem precoce para aqueles de alto risco. O manejo terapêutico inicial inclui antiagregação plaquetária e anticoagulação, equilibrando benefício isquêmico e risco hemorrágico. Persistem desafios relacionados à heterogeneidade das apresentações clínicas e às disparidades assistenciais, especialmente em mulheres e idosos. Em conjunto, os avanços recentes apontam para um modelo de cuidado progressivamente orientado pela estratificação de risco, protocolos padronizados e integração tecnológica.
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