The Genetic Basis of Coronary Artery Disease and Atrial Fibrillation: A Search for Disease Mechanisms and Therapeutic Targets.
The Genetic Basis of Coronary Artery Disease and Atrial Fibrillation: A Search for Disease Mechanisms and Therapeutic Targets.
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DOI：
10.1053/j.jvca.2015.01.031
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发表时间：
2015-10
影响因子：
2.8
通讯作者：
Wang Y
中科院分区：
文献类型：
--
作者：
Neelankavil J;Rau CD;Wang Y
冠状动脉疾病（CAD）和心律失常，如心房颤动（AF）显着有助于围手术期死亡率和发病率。AF（6.4%）和CAD（2.9%）患者的术后30天死亡率显著增加[1]。VISION试验表明，11.6%接受非心脏手术的患者术后肌钙蛋白水平升高，与参考组相比，这些患者的30天死亡率增加[2]。术后房颤患者住院时间更长，死亡率增加[3-6]。术后房颤不仅常见于心脏手术后，也常见于大型非心脏手术后，随着麻醉医生继续关注手术患者的围手术期护理，我们必须研究各种方法来降低接受非心脏手术的冠状动脉疾病和心律失常患者的死亡率和发病率。CAD和AF的遗传易感性在过去十年中受到了更多的关注，这是由于创新技术和人类基因组信息的快速获取提高了识别基因组中单核苷酸多态性的能力。尽管在CAD和AF的管理方面不断取得进展，但预防可能是减少我们患者人群中缺血性心脏病和房颤的最有效方法。医疗管理在围手术期预防主要心脏不良事件（MACE）方面发挥着重要作用，但2014年ACC/AHA指南反映了近期研究对围手术期β受体阻滞剂安全性和有效性的重要贡献。围手术期β受体阻滞剂的唯一I类建议是长期服用β受体阻滞剂的患者继续服用β受体阻滞剂[1]。高危心肌缺血患者或多重风险患者开始β受体阻滞剂治疗
Coronary artery disease (CAD) and arrhythmias such as atrial fibrillation (AF) significantly contribute to perioperative mortality and morbidity. The 30-day postoperative mortality rate is significantly increased in patients with AF (6.4%) and (CAD)(2.9%)[1]. The VISION trial demonstrated that 11.6% of patient undergoing non-cardiac surgery had increased troponin levels post-operatively, and these patients had an increased 30 day mortality compared to the reference group [2]. Post operative AF patients have longer hospital stays and increased mortality [3–6]. Postoperative AF is not only common after cardiac surgery, but is also seen after major non-cardiac surgery as well.As anesthesiologists continue to focus on perioperative care for surgical patients, we must examine all options for decreasing the mortality and morbidity for patients with coronary artery disease and arrhythmias undergoing non-cardiac surgery. The genetic predisposition for CAD and AF has garnered more attention in the past decade due to innovative technology and ready access to human genomic information that has improved the ability to identify single nucleotide polymorphisms in our genome. Although advances continue to be made in the management of CAD and AF, prevention will likely be the most effective way to decrease ischemic heart disease and atrial fibrillation in our patient population. Medical management has an important role for perioperative prevention of major adverse cardiac events (MACE), however the 2014 ACC/AHA guidelines reflect important contributions from recent studies regarding the safety and efficacy of perioperative beta blockade. The only class I recommendation for perioperative beta blockade is the continuation of beta blockers for patients who have been taking them chronically [1]. The initiation of beta blockers for patients with high risk myocardial ischemia or for patients with multiple risk