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Current trends and challenges in infective endocarditis. 感染性心内膜炎的当前趋势和挑战。
IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-08 DOI: 10.1097/HCO.0000000000001192
Shubh K Patel, Syed M Ali Hassan, Mahée Côté, Benjamin Leis, Bobby Yanagawa

Purpose of review: Infective endocarditis (IE) is a complex disease with increasing global incidence. This review explores recent trends in IE infection patterns, including healthcare-associated IE (HAIE), drug-use-associated IE (DUA-IE), multidrug-resistant organisms (MDROs), and challenges in managing prosthetic valve and device-related infections.

Recent findings: Staphylococcus aureus has emerged as the leading cause of IE, especially in HAIE and DUA-IE cases. Increasingly prevalent MDROs, such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci, pose further clinical challenges. Advances in molecular diagnostics have improved the detection of culture-negative endocarditis. The introduction of the AngioVAC percutaneous aspiration device promises to change the management of right and possibly some left sided IE. Multidisciplinary team management and early surgery have demonstrated improved outcomes including partnerships with psychiatry and addictions services for those with intravenous DUA-IE.

Summary: IE presents significant diagnostic and therapeutic challenges due to evolving infection patterns, MDROs, and HAIE. Early diagnosis using advanced imaging, appropriate early antimicrobial therapy, and multidisciplinary care, including timely surgery, are critical for optimizing patient outcomes.

审查目的:感染性心内膜炎(IE)是一种复杂的疾病,全球发病率不断上升。本综述探讨了 IE 感染模式的最新趋势,包括医疗相关 IE(HAIE)、药物使用相关 IE(DUA-IE)、耐多药菌(MDROs)以及人工瓣膜和装置相关感染的管理挑战:最近的研究结果:金黄色葡萄球菌已成为IE的主要病因,尤其是在HAIE和DUA-IE病例中。耐甲氧西林金黄色葡萄球菌和耐万古霉素肠球菌等MDROs的日益流行给临床带来了更多挑战。分子诊断技术的进步提高了对培养阴性心内膜炎的检测能力。AngioVAC 经皮抽吸装置的问世有望改变右腔 IE 的治疗方法,也可能改变部分左腔 IE 的治疗方法。多学科团队管理和早期手术改善了治疗效果,包括与精神病学和成瘾服务部门合作,为静脉注射 DUA-IE 的患者提供治疗。利用先进的成像技术进行早期诊断、适当的早期抗菌治疗和多学科护理(包括及时手术)对于优化患者预后至关重要。
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引用次数: 0
Is it feasible to treat atrial fibrillation at the time of minimally invasive coronary artery bypass grafting? 在微创冠状动脉旁路移植术时治疗心房颤动是否可行?
IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 Epub Date: 2024-08-13 DOI: 10.1097/HCO.0000000000001173
Stephen D Waterford, Niv Ad

Purpose of review: Coronary artery bypass grafting remains the most common operation performed by cardiac surgeons. As a result, a cardiac surgeon with a typical practice will most commonly encounter atrial fibrillation when performing coronary artery bypass grafting. In this review, we first emphasize the importance of treating atrial fibrillation in patients undergoing coronary bypass grafting. We review benefits of concomitant surgical ablation and its importance relative to complete coronary revascularization. We then discuss options to treat atrial fibrillation in a more minimally invasive manner in these patients, while still preserving treatment efficacy.

Recent findings: Surgical ablation at the time of coronary artery bypass grafting surgery could be as important as complete revascularization. Bi-atrial ablation provides superior rhythm control compared to left-sided ablation only.

Summary: We highlight various options for surgical ablation at the time of coronary artery bypass grafting surgery, and provide an algorithm for ablation in individual patients.

回顾的目的:冠状动脉搭桥术仍然是心脏外科医生最常进行的手术。因此,一般情况下,心脏外科医生在进行冠状动脉搭桥术时最常遇到心房颤动。在这篇综述中,我们首先强调了治疗冠状动脉搭桥术患者心房颤动的重要性。我们回顾了同时进行手术消融的益处及其相对于完全冠状动脉血运重建的重要性。然后,我们讨论了以更微创的方式治疗这些患者心房颤动的方案,同时仍能保持治疗效果:最新研究结果:在进行冠状动脉旁路移植手术时进行手术消融可能与完全血管再通一样重要。总结:我们重点介绍了冠状动脉旁路移植手术时手术消融的各种选择,并提供了针对个别患者的消融算法。
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引用次数: 0
Acute-on-chronic inflammation in acute myocardial infarction. 急性心肌梗死中的急性-慢性炎症。
IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 Epub Date: 2024-08-21 DOI: 10.1097/HCO.0000000000001176
Michael A Matter, Tristan Tschaikowsky, Barbara E Stähli, Christian M Matter

Purpose of review: Acute myocardial infarction (AMI) is heralded by chronic inflammation and entails an excessive burst of acute-on-chronic inflammation (AoCI). This review describes the evolution from understanding atherosclerosis as a chronic inflammatory disease, to recent efforts in optimizing anti-inflammatory therapy to patients with AMI. It highlights the challenges and opportunities in selecting the optimal patient with AMI to derive maximal benefit from early anti-inflammatory therapy.

Recent findings: The causal role of inflammation in atherosclerosis has been proven in large outcome trials. Since then, several smaller trials have sought to translate the concept of anti-inflammatory therapy targeting residual inflammatory risk to the dynamic early phase of AoCI after AMI. Current evidence highlights the importance of selecting patients with a high inflammatory burden. Surrogate criteria for large AMI (e.g., angiographic or electrocardiographic), as well as novel point-of-care biomarker testing may aid in selecting patients with particularly elevated AoCI. Additionally, patients presenting with AMI complicated by pro-inflammatory sequelae (e.g., atrial fibrillation, acute heart failure, left ventricular thrombosis) may dually profit from anti-inflammatory therapy.

Summary: Improved understanding of the mechanisms and dynamics of acute and chronic inflammatory processes after AMI may aid the strive to optimize early anti-inflammatory therapy to patients with AMI.

综述的目的:急性心肌梗死(AMI)是慢性炎症的先兆,并导致急性-慢性炎症(AoCI)的过度爆发。本综述介绍了从将动脉粥样硬化理解为慢性炎症性疾病,到最近为急性心肌梗死患者优化抗炎治疗的演变过程。它强调了选择最佳急性心肌梗塞患者以从早期抗炎治疗中获得最大益处所面临的挑战和机遇:最近的研究结果:炎症在动脉粥样硬化中的因果作用已在大型结果试验中得到证实。从那时起,几项较小的试验试图将针对残余炎症风险的抗炎治疗概念转化为急性心肌梗死后AoCI的动态早期阶段。目前的证据强调了选择高炎症负荷患者的重要性。大面积急性心肌梗死的替代标准(如血管造影或心电图)以及新型的护理点生物标记物检测可能有助于选择 AoCI 特别高的患者。此外,急性心肌梗死并发促炎症后遗症(如心房颤动、急性心力衰竭、左心室血栓形成)的患者也可从抗炎治疗中获益。摘要:加深对急性心肌梗死后急性和慢性炎症过程的机制和动态的了解,有助于努力优化急性心肌梗死患者的早期抗炎治疗。
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引用次数: 0
Complex issues in coronary artery surgery. 冠状动脉手术中的复杂问题。
IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 Epub Date: 2024-10-03 DOI: 10.1097/HCO.0000000000001171
Marc Ruel, Robert Roberts
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引用次数: 0
Lipoprotein(a) is a highly atherogenic lipoprotein: pathophysiological basis and clinical implications. 脂蛋白(a)是一种高度致动脉粥样硬化的脂蛋白:病理生理学基础和临床意义。
IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 Epub Date: 2024-08-13 DOI: 10.1097/HCO.0000000000001170
Elias Björnson, Martin Adiels, Jan Borén, Chris J Packard

Purpose of review: Lipoprotein(a) has been identified as a causal risk factor for atherosclerotic cardiovascular disease (ASCVD) and aortic valve stenosis. However, as reviewed here, there is ongoing debate as to the key pathogenic features of Lp(a) particles and the degree of Lp(a) atherogenicity relative to low-density lipoprotein (LDL).

Recent findings: Genetic analyses have revealed that Lp(a) on a per-particle basis is markedly (about six-fold) more atherogenic than LDL. Oxidized phospholipids carried on Lp(a) have been found to have substantial pro-inflammatory properties triggering pathways that may contribute to atherogenesis. Whether the strength of association of Lp(a) with ASCVD risk is dependent on inflammatory status is a matter of current debate and is critical to implementing intervention strategies. Contradictory reports continue to appear, but most recent studies in large cohorts indicate that the relationship of Lp(a) to risk is independent of C-reactive protein level.

Summary: Lp(a) is a highly atherogenic lipoprotein and a viable target for intervention in a significant proportion of the general population. Better understanding the basis of its enhanced atherogenicity is important for risk assessment and interpreting intervention trials.

综述目的:脂蛋白(a)已被确定为动脉粥样硬化性心血管疾病(ASCVD)和主动脉瓣狭窄的致病风险因素。然而,正如本文所述,关于脂蛋白(a)颗粒的主要致病特征以及脂蛋白(a)相对于低密度脂蛋白(LDL)的致动脉粥样硬化程度仍存在争议:遗传分析表明,脂蛋白(a)单个颗粒的致动脉粥样硬化性明显高于低密度脂蛋白(约六倍)。研究发现,脂蛋白(a)上的氧化磷脂具有很大的促炎特性,可触发可能导致动脉粥样硬化的途径。脂蛋白(a)与 ASCVD 风险的关联强度是否取决于炎症状态是目前争论的一个问题,也是实施干预策略的关键。相互矛盾的报告不断出现,但最近在大型队列中进行的大多数研究表明,脂蛋白(a)与风险的关系与 C 反应蛋白水平无关。摘要:脂蛋白(a)是一种高度致动脉粥样硬化的脂蛋白,是对相当一部分普通人群进行干预的可行目标。更好地了解其增强致动脉粥样硬化性的基础对于风险评估和解释干预试验非常重要。
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引用次数: 0
The role of advanced physiological guidance in contemporary coronary artery disease management. 先进的生理指导在当代冠状动脉疾病管理中的作用。
IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 Epub Date: 2024-09-19 DOI: 10.1097/HCO.0000000000001179
Daniel Munhoz, Kazumasa Ikeda, Frederic Bouisset, Koshiro Sakai, Atomu Tajima, Takuya Mizukami, Jeroen Sonck, Nils P Johnson, Carlos Collet

Purpose of review: This review evaluates the emerging role of the pullback pressure gradient (PPG) as a standardized metric for assessing coronary artery disease (CAD) patterns and its implications for clinical decision-making when managing patients undergoing percutaneous coronary interventions (PCIs). By integrating PPG with existing physiological assessments, this review highlights the potential benefits of PPG in predicting treatment outcomes and refining therapeutic strategies for CAD.

Recent findings: Recent studies, particularly the PPG Global study have demonstrated a strong correlation between PPG values and post-PCI outcomes, revealing that focal disease is associated with improved fractional flow reserve (FFR) and lower rates of adverse events than vessels with diffuse disease (low PPG). Additionally, PPG has been linked to specific atherosclerotic plaque characteristics, indicating its utility in identifying high-risk plaques. The integration of PPG with advanced imaging techniques further enhances the understanding of CAD patterns and their implications for treatment planning.

Summary: The PPG represents a significant advancement in the management of CAD, providing a reproducible and objective assessment of coronary artery disease patterns that can inform clinical decision-making. As research continues to explore the relationship among PPG, atherosclerotic characteristics, and patient outcomes, its integration into routine practice is expected to improve the effectiveness of PCI and optimize patient management strategies. Future studies are warranted to establish specific PPG thresholds and further investigate its potential in identifying vulnerable plaques and guiding treatment decisions.

综述目的:本综述评估了回拉压力梯度(PPG)作为评估冠状动脉疾病(CAD)模式的标准化指标所发挥的新作用,及其对管理经皮冠状动脉介入治疗(PCI)患者的临床决策的影响。通过将 PPG 与现有的生理评估相结合,本综述强调了 PPG 在预测治疗结果和完善 CAD 治疗策略方面的潜在优势:最近的研究,尤其是 PPG 全球研究表明,PPG 值与冠状动脉造影术后的预后之间存在很强的相关性,显示与弥漫性疾病(PPG 值低)的血管相比,病灶性疾病与分数血流储备(FFR)的改善和不良事件的发生率较低有关。此外,PPG 还与特定的动脉粥样硬化斑块特征有关,表明其在识别高风险斑块方面的作用。将 PPG 与先进的成像技术相结合,可进一步加深对冠状动脉粥样硬化模式及其对治疗计划的影响的了解。摘要:PPG 是冠状动脉粥样硬化治疗的一大进步,它可对冠状动脉疾病模式进行可重复的客观评估,为临床决策提供依据。随着研究不断探索 PPG、动脉粥样硬化特征和患者预后之间的关系,将其纳入常规实践有望提高 PCI 的有效性并优化患者管理策略。未来的研究需要建立特定的 PPG 阈值,并进一步研究其在识别易损斑块和指导治疗决策方面的潜力。
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引用次数: 0
Pathophysiology and clinical implications of coronary artery calcifications. 冠状动脉钙化的病理生理学和临床意义。
IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 Epub Date: 2024-09-13 DOI: 10.1097/HCO.0000000000001180
Luca Saba, Francesco Costa, Riccardo Cau

Purpose of review: To provide a summary of current understanding of coronary artery calcifications (CACs), outlining the role of calcium in atherosclerosis to comprehend the clinical implications of CAC.

Recent findings: CAC serves as a reliable indicator of coronary artery disease (CAD) and it is associated with cardiovascular events. In recognition of its significance, recent global guidelines have integrated CAC assessment into risk evaluation protocols, highlighting its role as a noninvasive tool for evaluating and stratifying patients' risk for cardiovascular events. Beyond the amount of CAC values, also, calcium morphology had been linked to cardiovascular events.By leveraging CAC assessment, healthcare providers can effectively up or down reclassify patients' risk and tailor preventive strategies accordingly. This comprehensive approach may involve lifestyle modifications, meticulous management of risk factors, and judicious use of preventive medications to mitigate the likelihood of future cardiovascular events, or withhold treatments in those without signs of CAC, to optimize resource use.

Summary: The identification of CAC burden and morphology through noninvasive imaging modalities can reclassify the prediction of future cardiovascular risk and serve as a risk modifier for atherosclerosis. These data underscore the utility of selectively using CAC assessment in both primary and secondary prevention strategies for atherosclerotic cardiovascular disease.

综述的目的:概述目前对冠状动脉钙化(CAC)的认识,概述钙在动脉粥样硬化中的作用,以理解 CAC 的临床意义:CAC是冠状动脉疾病(CAD)的可靠指标,与心血管事件有关。鉴于其重要性,最近的全球指南已将 CAC 评估纳入风险评估方案,强调其作为评估和分层患者心血管事件风险的无创工具的作用。除了 CAC 值的大小,钙形态也与心血管事件有关。通过利用 CAC 评估,医疗服务提供者可以有效地提高或降低患者的风险分级,并相应地制定预防策略。这种综合方法可能涉及生活方式的调整、风险因素的细致管理、预防性药物的明智使用,以降低未来发生心血管事件的可能性,或对无 CAC 征兆者暂缓治疗,以优化资源利用。摘要:通过无创成像模式识别 CAC 负担和形态,可对未来心血管风险的预测进行重新分类,并作为动脉粥样硬化的风险调节因素。这些数据强调了在动脉粥样硬化性心血管疾病的一级和二级预防策略中选择性使用 CAC 评估的实用性。
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引用次数: 0
Redo coronary artery bypass grafting: when and how. 重做冠状动脉旁路移植术:何时以及如何进行。
IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 Epub Date: 2024-08-12 DOI: 10.1097/HCO.0000000000001169
Benjamin Yang, Marijan Koprivanac, Faisal G Bakaeen

Purpose of review: Redo coronary artery bypass grafting (CABG) remains technically challenging with significant procedural risk but may be the best option for patients in whom repeat revascularization is indicated. This review summarizes the latest data regarding risk of redo CABG, who should receive this surgery, and how to achieve best outcomes.

Recent findings: Over the past two decades, the risk of performing redo CABG has declined and is approaching that of primary CABG in the hands of experienced surgeons. Nonetheless, patients for whom redo CABG is indicated tend to be older and have more complex medical comorbidities. Preoperative imaging is paramount in guiding sternal re-entry and mediastinal dissection, and in how to best employ rescue strategies when needed.

Summary: Patients with complex, progressive coronary disease with unprotected left anterior descending (LAD) coronary artery disease and prior coronary bypass may benefit from the durable, complete revascularization that redo CABG can offer with internal thoracic artery bypass to the LAD and, when possible, arterial inflow to other important coronary targets. Preoperative imaging, careful planning, meticulous surgical technique, myocardial protection, and an experienced surgical team are critical for optimal outcomes.

审查目的:重做冠状动脉旁路移植术(CABG)在技术上仍具有挑战性,手术风险很大,但可能是需要重复血管重建的患者的最佳选择。本综述总结了有关重做冠状动脉旁路移植术的风险、哪些患者应接受该手术以及如何获得最佳疗效的最新数据:在过去的二十年中,在经验丰富的外科医生手中,进行重做 CABG 的风险已经下降,并接近于初诊 CABG 的风险。然而,需要进行重做 CABG 的患者往往年龄较大,合并症较为复杂。术前成像在指导胸骨再入路、纵隔夹层以及在需要时如何最好地采用抢救策略方面至关重要。摘要:患有复杂、进展性冠状动脉疾病、无保护性左前降支(LAD)冠状动脉疾病和既往冠状动脉搭桥术的患者可能会受益于重做 CABG 所能提供的持久、完全的血管再通,即胸内动脉搭桥至 LAD,并在可能的情况下,动脉流入其他重要的冠状动脉靶点。术前成像、周密计划、细致的手术技巧、心肌保护以及经验丰富的手术团队是获得最佳疗效的关键。
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引用次数: 0
High lipoprotein(a) is a risk factor for peripheral artery disease, abdominal aortic aneurysms, and major adverse limb events. 高脂蛋白(a)是外周动脉疾病、腹主动脉瘤和肢体重大不良事件的危险因素。
IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 Epub Date: 2024-09-11 DOI: 10.1097/HCO.0000000000001168
Peter E Thomas, Signe Vedel-Krogh, Pia R Kamstrup

Purpose of review: To summarize evidence from recent studies of high lipoprotein(a) as a risk factor for peripheral artery disease (PAD), abdominal aortic aneurysms (AAA), and major adverse limb events (MALE). Additionally, provide clinicians with 10-year absolute risk charts enabling risk prediction of PAD and AAA by lipoprotein(a) levels and conventional risk factors.

Recent findings: Numerous studies support high lipoprotein(a) as an independent risk factor for PAD, AAA, and MALE. The strongest evidence is from the Copenhagen General Population Study (CGPS) and the UK Biobank, two large general population-based cohorts. In the CGPS, a 50 mg/dl higher genetically determined lipoprotein(a) associated with hazard ratios of 1.39 (1.24-1.56) for PAD and 1.21 (1.01-1.44) for AAA. Corresponding hazard ratio in the UK Biobank were 1.38 (1.30-1.46) and 1.42 (1.28-1.59). In CGPS participants with levels at least 99th (≥143 mg/dl) vs, less than 50th percentile (≤9 mg/dl), hazard ratios were 2.99 (2.09-4.30) for PAD and 2.22 (1.21-4.07) for AAA, with a corresponding incidence rate ratio for MALE of 3.04 (1.55-5.98) in participants with PAD.

Summary: Evidence from both observational and genetic studies support high lipoprotein(a) as a causal risk factor for PAD, AAA, and MALE, and highlight the potential of future lipoprotein(a)-lowering therapy to reduce the substantial morbidity and mortality associated with these diseases.

综述目的:总结近期关于高脂蛋白(a)是外周动脉疾病(PAD)、腹主动脉瘤(AAA)和主要肢体不良事件(MALE)风险因素的研究证据。此外,为临床医生提供 10 年绝对风险图表,以便通过脂蛋白(a)水平和传统风险因素对 PAD 和 AAA 进行风险预测:大量研究支持高脂蛋白(a)是 PAD、AAA 和 MALE 的独立风险因素。最有力的证据来自哥本哈根普通人群研究(CGPS)和英国生物库(UK Biobank)这两个大型普通人群队列。在哥本哈根总人口研究(CGPS)中,基因决定的脂蛋白(a)高 50 毫克/分升与 PAD 和 AAA 的危险比分别为 1.39(1.24-1.56)和 1.21(1.01-1.44)。英国生物库中的相应危险比分别为 1.38(1.30-1.46)和 1.42(1.28-1.59)。在血糖水平至少在第 99 位(≥143 mg/dl)与低于第 50 位(≤9 mg/dl)的 CGPS 参与者中,PAD 的危险比为 2.99(2.09-4.30),AAA 的危险比为 2.22(1.21-4.07),PAD 参与者中男性的相应发病率比为 3.04(1.55-5.98)。小结:观察性研究和遗传学研究的证据都支持高脂蛋白(a)是PAD、AAA和MALE的致病风险因素,并强调了未来降低脂蛋白(a)疗法降低与这些疾病相关的大量发病率和死亡率的潜力。
{"title":"High lipoprotein(a) is a risk factor for peripheral artery disease, abdominal aortic aneurysms, and major adverse limb events.","authors":"Peter E Thomas, Signe Vedel-Krogh, Pia R Kamstrup","doi":"10.1097/HCO.0000000000001168","DOIUrl":"10.1097/HCO.0000000000001168","url":null,"abstract":"<p><strong>Purpose of review: </strong>To summarize evidence from recent studies of high lipoprotein(a) as a risk factor for peripheral artery disease (PAD), abdominal aortic aneurysms (AAA), and major adverse limb events (MALE). Additionally, provide clinicians with 10-year absolute risk charts enabling risk prediction of PAD and AAA by lipoprotein(a) levels and conventional risk factors.</p><p><strong>Recent findings: </strong>Numerous studies support high lipoprotein(a) as an independent risk factor for PAD, AAA, and MALE. The strongest evidence is from the Copenhagen General Population Study (CGPS) and the UK Biobank, two large general population-based cohorts. In the CGPS, a 50 mg/dl higher genetically determined lipoprotein(a) associated with hazard ratios of 1.39 (1.24-1.56) for PAD and 1.21 (1.01-1.44) for AAA. Corresponding hazard ratio in the UK Biobank were 1.38 (1.30-1.46) and 1.42 (1.28-1.59). In CGPS participants with levels at least 99th (≥143 mg/dl) vs, less than 50th percentile (≤9 mg/dl), hazard ratios were 2.99 (2.09-4.30) for PAD and 2.22 (1.21-4.07) for AAA, with a corresponding incidence rate ratio for MALE of 3.04 (1.55-5.98) in participants with PAD.</p><p><strong>Summary: </strong>Evidence from both observational and genetic studies support high lipoprotein(a) as a causal risk factor for PAD, AAA, and MALE, and highlight the potential of future lipoprotein(a)-lowering therapy to reduce the substantial morbidity and mortality associated with these diseases.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"511-519"},"PeriodicalIF":2.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142362499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Coronary artery bypass grafting in acute coronary syndromes: modern indications and approaches. 急性冠状动脉综合征的冠状动脉旁路移植术:现代适应症和方法。
IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-01 Epub Date: 2024-09-09 DOI: 10.1097/HCO.0000000000001172
Sigrid Sandner, Alissa Florian, Marc Ruel

Purpose of review: Acute coronary syndromes (ACS) are a leading cause of morbidity and mortality worldwide, with approximately 1.2 million hospitalizations annually in the U.S. This review aims to explore the contemporary evidence regarding revascularization strategies, including percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), in ACS patients. It also addresses the unresolved questions concerning the optimal procedural aspects of surgery and antithrombotic therapy for secondary prevention postsurgery.

Recent findings: Recent studies highlight that while PCI is generally preferred for its timeliness in high-risk non-ST-elevation ACS (NSTE-ACS) patients, CABG offers a benefit in terms of cardiovascular events in those with multivessel disease, particularly in the presence of diabetes and higher coronary disease complexity. For ST-elevation myocardial infarction (STEMI), CABG is less frequently utilized due to the preference for primary PCI, but it remains crucial for patients with complex anatomy or failed PCI. Furthermore, the optimal timing and type of antiplatelet therapy post-CABG remain controversial, with current evidence supporting the use of dual antiplatelet therapy (DAPT) to reduce ischemic events but necessitating careful management to balance bleeding risks.

Summary: In patients with ACS, the choice between PCI and CABG depends on the complexity of coronary disease and patient comorbidities. CABG is particularly beneficial for multivessel disease in NSTE-ACS and specific STEMI cases where PCI is not feasible. The management of antiplatelet therapy postsurgery requires a nuanced approach to minimize bleeding risks while preventing thrombotic complications. Further randomized clinical trials are needed to solidify these findings and guide clinical practice.

综述目的:急性冠状动脉综合征(ACS)是全球发病率和死亡率的主要原因,美国每年约有 120 万人住院治疗。本综述旨在探讨有关 ACS 患者血管重建策略的当代证据,包括经皮冠状动脉介入治疗(PCI)和冠状动脉旁路移植术(CABG)。它还探讨了手术的最佳程序方面以及术后二级预防的抗血栓治疗方面尚未解决的问题:最新研究结果表明,对于高危的非 STE-抬高型 ACS(NSTE-ACS)患者,虽然 PCI 因其及时性而受到青睐,但对于多血管疾病患者,尤其是糖尿病患者和冠状动脉疾病复杂性较高的患者,CABG 在心血管事件方面更有优势。对于 ST 段抬高型心肌梗死(STEMI)患者,由于更倾向于进行初级 PCI,因此 CABG 的使用率较低,但对于解剖结构复杂或 PCI 失败的患者来说,CABG 仍然至关重要。此外,CABG 术后抗血小板治疗的最佳时机和类型仍存在争议,目前的证据支持使用双重抗血小板治疗(DAPT)来减少缺血性事件,但需要谨慎管理以平衡出血风险。摘要:对于 ACS 患者,PCI 和 CABG 之间的选择取决于冠状动脉疾病的复杂性和患者的合并症。CABG 尤其适用于 NSTE-ACS 中的多血管疾病,以及无法进行 PCI 的特定 STEMI 病例。术后抗血小板治疗的管理需要采取细致入微的方法,以最大限度地降低出血风险,同时预防血栓并发症。需要进一步的随机临床试验来巩固这些发现并指导临床实践。
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引用次数: 0
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Current Opinion in Cardiology
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