Concord Repatriation General Hospital, Sydney, NSW.
Med J Aust. 2013 Aug 5;199(3):174-8. doi: 10.5694/mja12.11224.
Acute coronary syndrome (ACS; myocardial infarction and unstable angina) is the leading cause of mortality in Australia, and those who survive one ACS event are at significant risk of experiencing another. Access to evidence-based and optimal ACS management in both the acute and long-term periods is of great importance. Management of ACS should include appropriate timely revascularisation, medical therapy and ongoing secondary prevention. A key consideration in selecting acute antithrombotic therapies is a careful determination of the risk of bleeding versus risk of recurrent ischaemia. Although there is a strong evidence base for the urgency of delivery and the quality of acute care, knowledge translation is suboptimal. There remains a need for ongoing research and policy development aimed at improving ease and equity of access to evidence-based care. Despite universal guideline recommendations for ongoing secondary prevention strategies, research indicates suboptimal use of evidence-based medications, poor adherence to lifestyle recommendations, and low levels of participation in traditional cardiac rehabilitation. Contemporary secondary prevention programs are evolving into flexible, multifaceted interventions to provide maximal clinical benefits to a majority of patients.
急性冠状动脉综合征（ACS；心肌梗死和不稳定型心绞痛）是澳大利亚的主要死亡原因，而那些经历过一次 ACS 事件的患者再次发生 ACS 的风险显著增加。在急性和长期阶段获得基于证据的最佳 ACS 管理非常重要。ACS 的管理应包括适当的及时血运重建、药物治疗和持续的二级预防。在选择急性抗血栓治疗时，关键考虑因素是仔细确定出血风险与再次发生缺血的风险。尽管有强有力的证据支持急性护理的紧迫性和质量，但知识转化仍不理想。仍需要持续的研究和政策制定，以改善基于证据的护理的可及性和公平性。尽管普遍的指南建议持续进行二级预防策略，但研究表明，基于证据的药物使用不足，对生活方式建议的依从性差，以及传统心脏康复的参与度低。当代二级预防计划正在发展成为灵活的、多方面的干预措施，以最大限度地为大多数患者提供临床获益。
