Managing chronic coronary syndrome: how do we achieve optimal patient outcomes?

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Expert Review of Cardiovascular Therapy Pub Date : 2024-06-01 Epub Date: 2024-05-20 DOI:10.1080/14779072.2024.2357344
Antonis A Manolis, Theodora A Manolis, Antonis S Manolis
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引用次数: 0

Abstract

Introduction: Chronic coronary syndrome (CCS) remains the leading cause of death worldwide with high admission/re-admission rates. Medical databases were searched on CCS & its management.

Areas covered: This review discusses phenotypes per stress-echocardiography, noninvasive/invasive testing (coronary computed-tomography angiography-CCTA; coronary artery calcium - CAC score; echocardiography assessing wall-motion, LV function, valvular disease; biomarkers), multidisciplinary management (risk factors/anti-inflammatory/anti-ischemic/antithrombotic therapies and revascularization), newer treatments (colchicine/ivabradine/ranolazine/melatonin), cardiac rehabilitation/exercise improving physical activity and quality-of-life, use of the implantable-defibrillator, and treatment with extracorporeal shockwave-revascularization for refractory symptoms.

Expert opinion: CCS is age-dependent, leading cause of death worldwide with high hospitalization rates. Stress-echocardiography defines phenotypes and guides prophylaxis and management. CAC is a surrogate for atherosclerosis burden, best for patients of intermediate/borderline risk. Higher CAC-scores indicate more severe coronary abnormalities. CCTA is preferred for noninvasive detection of CAC and atherosclerosis burden, determining stenosis' functional significance, and guiding management. Combining CAC score with CCTA improves diagnostic yield and assists prognosis. Echocardiography assesses LV wall-motion and function and valvular disease. Biomarkers guide diagnosis/prognosis. CCS management is multidisciplinary: risk-factor management, anti-inflammatory/anti-ischemic/antithrombotic therapies, and revascularization. Newer therapies comprise colchicine, ivabradine, ranolazine, melatonin, glucagon-like peptide-1-receptor antagonists. Cardiac rehabilitation/exercise improves physical activity and quality-of-life. An ICD protects from sudden death. Extracorporeal shockwave-revascularization treats refractory symptoms.

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管理慢性冠状动脉综合征:我们如何实现患者的最佳治疗效果?
简介慢性冠状动脉综合征(CCS)仍是全球死亡的主要原因,其入院/再入院率很高。我们检索了有关慢性冠状动脉综合征及其管理的医学数据库:本综述讨论了应力超声心动图、无创/有创检测(冠状动脉计算机断层扫描血管造影-CCTA;冠状动脉钙化-CAC 评分;评估室壁运动、左心室功能、瓣膜病的超声心动图;生物标志物)、多学科管理(风险因素/抗炎/抗缺血/抗血栓治疗和血管再通)、新的治疗方法(秋水仙碱/伊伐布雷定/雷诺拉嗪/褪黑激素)、心脏康复/改善体力活动和生活质量的运动、植入式除颤器的使用以及针对难治性症状的体外冲击波血管再通治疗。专家意见:慢性心肌梗死与年龄有关,是全球的主要死因,住院率很高。负荷超声心动图可确定表型并指导预防和治疗。CAC 是动脉粥样硬化负担的代用指标,最适用于中等/边缘风险患者。CAC 分数越高,表明冠状动脉异常越严重。CCTA 是无创检测 CAC 和动脉粥样硬化负荷、确定狭窄的功能意义和指导治疗的首选。将 CAC 评分与 CCTA 结合使用可提高诊断率并有助于预后。超声心动图可评估左心室壁运动和功能以及瓣膜疾病。生物标志物可指导诊断/预后。CCS 的治疗是多学科的:风险因素管理、抗炎/抗缺血/抗血栓治疗和血管重建。新疗法包括秋水仙碱、伊伐布雷定、雷诺拉嗪、褪黑素、胰高血糖素样肽-1 受体拮抗剂。心脏康复/锻炼可改善体力活动和生活质量。ICD 可预防猝死。体外冲击波血管重建治疗难治性症状。
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来源期刊
Expert Review of Cardiovascular Therapy
Expert Review of Cardiovascular Therapy CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
3.70
自引率
0.00%
发文量
82
期刊介绍: Expert Review of Cardiovascular Therapy (ISSN 1477-9072) provides expert reviews on the clinical applications of new medicines, therapeutic agents and diagnostics in cardiovascular disease. Coverage includes drug therapy, heart disease, vascular disorders, hypertension, cholesterol in cardiovascular disease, heart disease, stroke, heart failure and cardiovascular surgery. The Expert Review format is unique. Each review provides a complete overview of current thinking in a key area of research or clinical practice.
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