Personalizing the Competing Risks for Thrombotic and Bleeding Events in Ischemia With Nonobstructed Coronary Arteries.
Personalizing the Competing Risks for Thrombotic and Bleeding Events in Ischemia With Nonobstructed Coronary Arteries.
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个性化无阻塞冠状动脉缺血中血栓和出血事件的竞争风险。
DOI：
10.1016/j.jcin.2021.12.010
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发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Berry C
中科院分区：
文献类型：
--
作者：
Berry C
分数血流储备（FFR）是一种基于证据的技术，用于指导慢性冠状动脉综合征患者冠状动脉病变严重程度的评估1和急性冠状动脉综合征患者非梗死相关动脉疾病的评估。2与单用最佳药物治疗相比，ffr引导下经皮冠状动脉介入治疗可改善临床疗效。当代实践已经发展到将FFR纳入指导血运重建的决策，在中度严重的冠状动脉病变中最明显。然而，非阻塞性冠状动脉疾病患者发生动脉粥样硬化血栓事件的风险增加。在这种情况下，在抗血栓治疗和患者出血风险之间取得平衡是冠状动脉疾病管理的关键考虑因素。双重抗血小板治疗和/或抗凝治疗的抗血栓益处被出血的风险抵消了，出血本身是发病率和死亡率的一个重要原因。因此，最新的欧洲心脏病学会指南推荐使用风险评分来个性化具有不同程度血栓形成和出血风险的患者的双重抗血小板治疗持续时间。各种风险评分已经公布，以提高预测能力
Fractional flow reserve (FFR) is an evidencebased technique to guide the assessment of coronary artery lesion severity in chronic coronary syndromes 1 and for non-infarct-related artery disease in acute coronary syndrome. 2 FFR-guided percutaneous coronary intervention with optimal medical therapy may improve clinical outcomes compared with optimal medical therapy alone. 3 Contemporary practice has evolved to incorporate FFR to guide revascularization decisions, with utility most evident in coronary lesions of intermediate severity. Nonetheless, patients with nonobstructive coronary artery disease carry an enhanced risk for atherothrombotic events.Within this setting, striking a balance between antithrombotic therapy and patient bleeding risk is a key consideration in the management of coronary artery disease. The antithrombotic benefits of dualantiplatelet therapy and/or anticoagulation are counterbalanced by the risk for hemorrhage, itself a significant cause of morbidity and mortality. 4 Consequently, the most recent European Society of Cardiology guidelines 5 recommend the use of risk scores to personalize the duration of dual-antiplatelet therapy in patients with different degrees of thrombotic and bleeding risk. Various risk scores have been published to improve the predictive power for