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 Current Opinion in Cardiology Pub Date : 2024-11-01 Epub Date: 2024-09-09 DOI:10.1097/HCO.0000000000001172
Sigrid Sandner, Alissa Florian, Marc Ruel
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引用次数: 0

摘要

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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Coronary artery bypass grafting in acute coronary syndromes: modern indications and approaches.

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.

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来源期刊
Current Opinion in Cardiology
Current Opinion in Cardiology 医学-心血管系统
CiteScore
4.20
自引率
4.30%
发文量
78
审稿时长
6-12 weeks
期刊介绍: ​​​​​​Current Opinion in Cardiology is a bimonthly publication offering a unique and wide ranging perspective on the key developments in the field. Each issue features hand-picked review articles from our team of expert editors. With fourteen disciplines published across the year – including arrhythmias, molecular genetics, HDL cholesterol and clinical trials – every issue also contains annotated reference detailing the merits of the most important papers.
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