Guedeney Paul, Collet Jean-Philippe
Institut de Cardiologie, Sorbonne Université, ACTION Study Group, INSERM UMRS_1166, Hôpital Pitié-Salpêtrière (Assistance Publique-Hôpitaux de Paris), 75013 Paris, France.
J Clin Med. 2020 Oct 28;9(11):3474. doi: 10.3390/jcm9113474.
The management of acute coronary syndrome (ACS) has been at the center of an impressive amount of research leading to a significant improvement in outcomes over the last 50 years. The 2020 European Society of Cardiology (ESC) Guidelines for the management of patients presenting without persistent ST-segment elevation myocardial infarction have incorporated the most recent breakthroughs and updates from large randomized controlled trials (RCT) on the diagnosis and management of this disease. The purpose of the present review is to describe the main novelties and the rationale behind these recommendations. Hence, we describe the accumulating evidence against P2Y receptors inhibitors pretreatment prior to coronary angiography, the preference for prasugrel as leading P2Y inhibitors in the setting of ACS, and the numerous available antithrombotic regimens based on various durations of dual or triple antithrombotic therapy, according to the patient ischemic and bleeding risk profiles. We also detail the recently implemented 0 h/1 h and 0 h/2 h rule in, rule out algorithms and the growing role of computed coronary tomography angiography to rule out ACS in patients at low-to-moderate risk.
在过去50年里，急性冠状动脉综合征（ACS）的管理一直是大量研究的核心，这使得治疗结果有了显著改善。2020年欧洲心脏病学会（ESC）关于无持续性ST段抬高型心肌梗死患者管理的指南纳入了关于该疾病诊断和管理的大型随机对照试验（RCT）的最新突破和更新内容。本综述的目的是描述这些建议背后的主要新内容和基本原理。因此，我们描述了越来越多反对在冠状动脉造影前使用P2Y受体抑制剂进行预处理的证据、在ACS情况下将普拉格雷作为主要P2Y抑制剂的偏好，以及根据患者的缺血和出血风险状况基于不同持续时间的双联或三联抗栓治疗的众多可用抗栓方案。我们还详细介绍了最近在排除算法中实施的0小时/1小时和0小时/2小时规则，以及计算机断层扫描冠状动脉造影在排除低至中度风险患者的ACS方面日益重要的作用。
