基于指南的ST段抬高型心肌梗死后长期二级预防治疗与风险因素控制最新进展

Recent Advances on Long-term Secondary Prevention and Risk Factors Control for ST-segment Elevation Myocardial Infarction Based on the Latest Evidence

ST段抬高型心肌梗死(STEMI)患者急性期的关键治疗是快速再灌注,成功再灌注后所有患者处于心血管事件再发极高危状态,需要依据国内外最新进展推荐进行二级预防治疗和风险因素控制。STEMI患者的长期管理治疗包括:心肌缺血的无创性评价,左心室功能和心源性猝死评价,戒烟,以运动为基础的心脏康复,饮食和体质量控制,血压控制,血糖管理,降脂治疗,长期抗栓治疗,β-受体阻滞剂,血管紧张素转换酶抑制剂(ACEI)和血管紧张素Ⅱ受体拮抗剂(ARB),盐皮质激素受体拮抗剂(MRA),改善循证治疗依从性,以及促进治疗协调性的医疗保健体系。

In patients with ST-segment elevation myocardial infarction(STEMI),the key management is fast reperfusion therapy in the acute setting;after successful reperfusion,all patients are considered to be at sufficiently high risk to merit interventions for secondary prevention and risk factors based on the latest domestic and foreign evidence.Long-term management for STEMI includes noninvasive testing for ischemia,assessment of left ventricular function and risk for sudden cardiac death(SCD),cessation of smoking,exercise-based cardiac rehabilitation,diet advice and weight control,optimal blood pressure control,hyperglycemic management,lipid-lowering therapy,long-term antithrombotic therapy,betablockers,angiotensin-converting enzyme inhibitors(ACEI) and angiotensin Ⅱ receptor blockers(ARB),mineralocorticoid receptor antagonist(MRA) therapy,improvement of evidence-based treatment compliance,and system of care to promote care coordination.