CBS 2019
CBSMD教育中心
中 文

科学研究

Abstract

Recommended Article

The Year in Cardiovascular Medicine 2020: Imaging: Looking back on the Year in Cardiovascular Medicine for 2020 in the field of imaging are Fausto Pinto, José Luis Zamorano and Chiara Bucciarelli-Ducci. Judy Ozkan speaks with them Optical coherence tomography and intravascular ultrasound assessment of the anatomic size and wall thickness of a muscle bridge segment Age-Related Characteristics and Outcomes of Patients With Heart Failure With Preserved Ejection Fraction Atherosclerotic plaque with ultrasonic attenuation affects coronary reflow and infarct size in patients with acute coronary syndrome: an intravascular ultrasound study Primary Prevention of Heart Failure in Women Myocardial bridging: contemporary understanding of pathophysiology with implications for diagnostic and therapeutic strategies Timing of Intervention in Aortic Stenosis Sex- and Race-Related Differences in Characteristics and Outcomes of Hospitalizations for Heart Failure With Preserved Ejection Fraction

Review ArticleVolume 74, Issue 12, September 2019

JOURNAL:J Am Coll Cardiol. Article Link

From Early Pharmacology to Recent Pharmacology Interventions in Acute Coronary Syndromes

Szummer K, Jernberg T, Wallentin L. Keywords: ACS; antithrombotic treatment; clinical trials; MI; Non STEM; outcomes; PCI; reperfusion treatment; revascularization; STEMI

ABSTRACT


This focus seminar will take the reader through the history and pivotal trials that have formed the current state-of-the-art management for acute coronary syndromes. The identification of a ruptured plaque with thrombus formation and subsequent occlusion or downstream embolization in the coronary artery was the key to developing new and effective treatment strategies. The traditional wait-and-see approach with prolonged bedrest was replaced in the 1980s by immediate pharmacological reperfusion of the occluded coronary artery and long-term aspirin to prevent reinfarction. Mechanical reperfusion with percutaneous coronary intervention with stenting and more intense platelet inhibition with P2Y12 inhibitors further improved outcomes from early 2000s. Adjunctive treatment regimens, including anticoagulants, statins, and neurohormonal inhibition, were found to further reduce mortality and prevent new infarctions. Taken together, the use of new combined pharmacological and interventional treatment strategies has led to a remarkable decrease in 1-year mortality from around 22% in 1995 to around 11% by 2014.