Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Division of Cardiology, Department of Medical Sciences, Città della Scienza e della Salute Hospital, University of Turin, Turin, Italy.
Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy.
J Am Coll Cardiol. 2018 Dec 11;72(23 Pt A):2886-2903. doi: 10.1016/j.jacc.2018.09.052.
Following an acute coronary syndrome (ACS), heightened predisposition to atherothrombotic events may persist for years. Advances in understanding the pathobiology that underlies this elevated risk furnish a mechanistic basis for devising long-term secondary prevention strategies. Recent progress in ACS pathophysiology has challenged the focus on single "vulnerable plaques" and shifted toward a more holistic consideration of the "vulnerable patient," thus highlighting the primacy of medical therapy in secondary prevention. Despite current guideline-directed medical therapy, a consistent proportion of post-ACS patients experience recurrent atherothrombosis due to unaddressed "residual risk": contemporary clinical trials underline the pivotal role of platelets, coagulation, cholesterol, and systemic inflammation and provide a perspective on a personalized, targeted approach. Emerging data sheds new light on heretofore unrecognized residual risk factors. This review aims to summarize evolving evidence relative to secondary prevention of atherothrombosis, with a focus on recent advances that promise to transform the management of the post-ACS patient.
在急性冠脉综合征（ACS）后，动脉粥样血栓事件的高度易感性可能会持续多年。对潜在风险机制的深入理解为制定长期二级预防策略提供了理论基础。ACS 病理生理学的最新进展挑战了单一“易损斑块”的关注焦点，转向更全面地考虑“易损患者”，从而突出了医学治疗在二级预防中的首要地位。尽管目前有指南指导的医学治疗，但由于未解决的“残余风险”，仍有相当比例的 ACS 后患者会发生复发性动脉粥样血栓形成：当代临床试验强调了血小板、凝血、胆固醇和全身炎症的关键作用，并为个性化、靶向治疗提供了一个视角。新出现的数据揭示了以前未被认识的残余风险因素。这篇综述旨在总结与动脉粥样血栓形成二级预防相关的不断发展的证据，重点关注有望改变 ACS 后患者管理的最新进展。
