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How can we improve acute coronary syndrome outc

机译:我们如何改善急性冠脉综合征

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Improvement in the prognosis of patients with acute coronary syndromes (ACS) is primarily driven by a reduction in intrahospital sudden death observed after the introduction of coronary care units and myocardial revascularization using percutaneous coronary intervention. Secondary prevention using pharmacological agents, has also contributed to improved prognosis. Pharmacology has been a major contributor to the reduction in left ventricular dysfunction but also in the reduction of recurrent ischaemic events. In particular, antithrombotic agents are key players in the advancement of percutaneous myocardial revascularization. The challenge now is to use the right drug for the right patient at the right time. Hypersensitive troponin testing allows a more accurate identification of ACS patients and we are now treating more fragile patients in whom the net clinical benefit of antithrombotic agents is not always so clear-cut. Better defining the patients who will benefit from the new P2Y12 inhibitors or direct factor Xa inhibitors should be the priority for clinical investigations. Indeed, these powerful agents have been labelled for indications that do not always match our routine practice. Our objective is to review the evidence on the ongoing changes and the recommendations to optimize the utilization of these agents.
机译:急性冠状动脉综合征(ACS)患者预后的改善主要是由引入冠状动脉护理单位和使用经皮冠状动脉介入治疗进行的心肌血运重建后院内猝死减少所致。使用药物治疗的二级预防也有助于改善预后。药理学一直是减少左心功能不全的主要贡献者,但也减少了复发性缺血事件。特别地,抗栓剂是经皮心肌血运重建进展的关键因素。现在的挑战是在正确的时间为正确的患者使用正确的药物。肌钙蛋白的超敏检测可以更准确地识别ACS患者,我们现在正在治疗更脆弱的患者,在这些患者中,抗栓剂的净临床收益并不总是那么明确。更好地确定将受益于新型P2Y12抑制剂或直接因子Xa抑制剂的患者应成为临床研究的重点。确实,这些功能强大的代理已被标记为并非总是与我们的常规实践相符的适应症。我们的目标是审查有关正在进行的变更的证据和建议,以优化这些代理的利用。

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