Novel functional risk factors for the prediction of cardiovascular events in vulnerable patients following acute coronary syndrome.
Novel functional risk factors for the prediction of cardiovascular events in vulnerable patients following acute coronary syndrome.
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DOI：
10.1253/circj.cj-12-0248
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发表时间：
2012
期刊：
影响因子：
--
通讯作者：
Lerman A
中科院分区：
文献类型：
--
作者：
Reriani MK;Flammer AJ;Jama A;Lerman LO;Lerman A
多年来，急性冠状动脉综合征（ACS）患者的临床结局有了相当大的改善。尽管急性死亡率显著降低，但大部分ACS后患者继续发生不良心血管（CV）事件，长期死亡率较高，总体医疗管理欠佳。长期风险预测工具依赖于传统的CV风险因素，并在特定人群中开发和验证。然而，已确定的CV风险因素只能解释一半或更少的CV事件。因此，这些风险模型在确定长期不良结局的个体风险或帮助识别对治疗无反应的个体患者方面可能不是最佳的。确定与血栓性并发症和快速进展的可能性增加相关的特定斑块特征导致了易损斑块的概念。近年来，“易损心肌”（即易发生心肌缺血和致命性心律失常的心肌）已被证明在预后中起重要作用。易损斑块和易损心肌均与功能性血管异常相关，如内皮功能障碍，被认为是冠状动脉疾病发生、发展和并发症的关键事件。内皮功能障碍可能作为一个潜在的统一机制，将独立预测ACS患者接受血运重建的长期结果。
Over the years there has been considerable improvement in the clinical outcomes of patients treated for acute coronary syndrome (ACS). Despite a significant reduction in acute mortality, a large percentage of patients post ACS continue to experience adverse cardiovascular (CV) events, with high long-term mortality rates and overall suboptimal medical management. Long-term risk prediction tools rely on traditional CV risk factors and are developed and validated in specific populations. Established CV risk factors, however, only explain half or fewer of CV events. These risk models may thus not be optimal in determining individual risk for long-term adverse outcomes or in helping to identify individual patients who do not respond to therapy. Identifying the specific plaque characteristics associated with increased likelihood for thrombotic complications and rapid progression has led to the concept of the vulnerable plaque. Recently, “vulnerable myocardium” (ie, myocardium that is prone to myocardial ischemia and fatal arrhythmia) has been shown to play an important role in outcome. Both vulnerable plaque and vulnerable myocardium are associated with functional vascular abnormalities, such as endothelial dysfunction, which are considered a key event in the initiation, progression and complications of coronary artery disease. Endothelial dysfunction may serve as an underlying unifying mechanism that would independently predict long-term outcome in patients with ACS undergoing revascularization.
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DOI：
10.1016/s0735-1097(01)01203-7
发表时间：
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影响因子：
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