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<正>急性冠状动脉综合征(acute coronary syndrome,ACS)是由冠状动脉粥样硬化斑块破裂或侵蚀导致血栓形成、引发急性供血中断的一组临床综合征,包括ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)、非ST段抬高型心肌梗死(non-ST segment elevation myocardial infarction,NSTEMI)及不稳定性心绞痛。尽管在血运重建、抗栓与调脂治疗方面取得重大进展,ACS仍是全球心血管死亡的首要原因。近年来,ACS疾病谱发生显著演变:非阻塞性冠状动脉疾病、微血管功能障碍及供需失衡型心肌梗死比例上升;同时,代谢性危险因素普遍化及人口老龄化加重了疾病负担。最新指南与研究推动ACS防治理念从“缺血事件管理”转向“动脉粥样硬化全过程干预”。本述评在系统回顾最新证据与指南更新的基础上,强调以动脉粥样硬化为中心的全生命周期防控理念,并展望未来关键方向。
Abstract:[1]Bergmark BA, Mathenge N, Merlini PA, et al. Acute coronary syndromes[J]. Lancet, 2022, 399(10332):1347-1358. DOI:10.1016/S0140-6736(21)02391-6.
[2]Zaman S, Wasfy JH, Kapil V, et al. The Lancet Commission on rethinking coronary artery disease:moving from ischaemia to atheroma[J]. Lancet, 2025, 405(10486):1264-1312. DOI:10.1016/S0140-6736(25)00055-8.
[3]Liu MB, He XY, Yang XH, et al. Interpretation of annual report on cardiovascular health and diseases in China 2024[J]. Biomed Environ Sci, 2025, 38(8):893-917. DOI:10.3967/bes2025.099.
[4]Reynolds HR, Smilowitz NR. Ischaemia with non-obstructive coronary arteries in the 2024 European Society of Cardiology guidelines for the management of chronic coronary syndromes[J].Eur Heart J Acute Cardiovasc Care, 2025, 14(3):173-177. DOI:10.1093/ehjacc/zuaf005.
[5]Kraler S, Mueller C, Libby P, et al. Acute coronary syndromes:mechanisms, challenges, and new opportunities[J]. Eur Heart J, 2025,46(29):2866-2889. DOI:10.1093/eurheartj/ehaf289.
[6]Boden WE, De Caterina R, Kaski JC, et al. Myocardial ischemic syndromes:a new nomenclature to harmonize evolving international clinical practice guidelines[J]. Circulation, 2024, 150(20):1631-1637. DOI:10.1161/CIRCULATIONAHA.123.065656.
[7]Braunwald E.Will primordial prevention change cardiology?[J]. Eur Heart J, 2023, 44(35):3307-3308. DOI:10.1093/eurheartj/ehad459.
[8]Lloyd-Jones DM, Allen NB, Anderson CAM, et al. Life’s essential8:updating and enhancing the american heart association's construct of cardiovascular health:a presidential advisory from the American Heart Association[J]. Circulation, 2022, 146(5):e18-e43. DOI:10.1161/CIR.0000000000001078.
[9]Rao SV, O’Donoghue ML, Ruel M, et al. 2025 ACC/AHA/ACEP/NAEMSP/SCAI guideline for the management of patients with acute coronary syndromes:a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines[J]. Circulation, 2025, 151(13):e771-e862. DOI:10.1161/CIR.0000000000001309.
[10]Reddy RK, Koeckerling D, Eichhorn C, et al. Early invasive or conservative strategies for older patients with acute coronary syndromes:a meta-analysis[J]. JAMA Intern Med, 2025, 185(8):966-975. DOI:10.1001/jamainternmed.2025.2058.
[11]Landi A, Gorog DA, Valgimigli M.Swinging pendulum between risks and benefits of antiplatelet agents:a call for consistency in the interpretation of evidence and guideline recommendations[J].Circulation, 2025, 151(2):126-128. DOI:10.1161/CIRCULATIONAHA.124.070797.
[12]Gao C, Zhu B, Ouyang F, et al. Stepwise dual antiplatelet therapy deescalation in patients after drug coated balloon angioplasty(RECCAGEFREEⅡ):multicentre, randomised, open label, assessor blind,non-inferiority trial[J]. BMJ, 2025, 388:e082945. DOI:10.1136/bmj-2024-082945.
[13]Mach F, Koskinas KC, Roeters van Lennep JE, et al. 2025 focused update of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias[J]. Atherosclerosis, 2025, 409:120479. DOI:10.1016/j.atherosclerosis.2025.120479.
[14]Sinha SS, Morrow DA, Kapur NK, et al. 2025 concise clinical guidance:an acc expert consensus statement on the evaluation and management of cardiogenic shock:a report of the American College of Cardiology Solution Set Oversight Committee[J]. J Am Coll Cardiol, 2025, 85(16):1618-1641. DOI:10.1016/j.jacc.2025.02.018.
[15]Butler J, Hammonds K, Talha KM, et al. Incident heart failure and recurrent coronary events following acute myocardial infarction[J].Eur Heart J, 2025, 46(16):1540-1550. DOI:10.1093/eurheartj/ehae885.
[16]Paoli G, Notarangelo MF, Mattioli M, et al. ALLiance for sEcondary PREvention after an acute coronary syndrome. The ALLEPRE trial:a multicenter fully nurse-coordinated intensive intervention program[J].Am Heart J, 2018, 203:12-16. DOI:10.1016/j.ahj.2018.06.001.
[17]McLachlan A, Kerr A, Lee M. A nurse-led and medically supported outpatient follow-up model following an acute coronary syndrome is as safe and effective as medical follow-up alone(ANZACS-QI 69)[J].N Z Med J, 2022, 135(1563):12-28. DOI:10.26635/6965.5787.
基本信息:
中图分类号:R541.4
引用信息:
[1]周玉杰,马美时.急性冠状动脉综合征的最新研究进展与未来展望[J].中华老年心脑血管病杂志,2026,28(01):1-3.
基金信息:
国家重点研发计划项目(2022YFC3602500)
2026-01-09
2026-01-09