Medical Therapy for Long-Term Prevention of Atherothrombosis Following an Acute Coronary Syndrome JACC State-of-the-Art Review

[摘要] Following an acute coronary syndrome (ACS), heightened predisposition to atherothrombotic events may persist for years. Advances in understanding the pathobiology that underlies this elevated risk furnish a mechanistic basis for devising long-term secondary prevention strategies. Recent progress in ACS pathophysiology has challenged the focus on single vulnerable plaques and shifted toward a more holistic consideration of the vulnerable patient, thus highlighting the primacy of medical therapy in secondary prevention. Despite current guideline-directed medical therapy, a consistent proportion of post-ACS patients experience recurrent atherothrombosis due to unaddressed residual risk: contemporary clinical trials underline the pivotal role of platelets, coagulation, cholesterol, and systemic inflammation and provide a perspective on a personalized, targeted approach. Emerging data sheds new light on heretofore unrecognized residual risk factors. This review aims to summarize evolving evidence relative to secondary prevention of atherothrombosis, with a focus on recent advances that promise to transform the management of the post-ACS patient. (c) 2018 Published by Elsevier on behalf of the American College of Cardiology Foundation.

[发布日期] 2018-12-11

[关键词] atherosclerosis;cholesterol;inflammation;post-MI stable coronary artery disease;residual risk;thrombosis