The coexistence of coronary artery disease(CAD)and atrial fibrillation(AF)is common in clinical practice.Patients with CAD require antiplatelet therapy to reduce the occurrence of myocardial ischemic events.However,pa...The coexistence of coronary artery disease(CAD)and atrial fibrillation(AF)is common in clinical practice.Patients with CAD require antiplatelet therapy to reduce the occurrence of myocardial ischemic events.However,patients with AF at high risk of thromboembolism require oral anticoagulants to reduce the occurrence of thromboembolic events such as stroke.In cases where CAD coexists with AF,the combined use of antiplatelet and anticoagulation therapy can effectively reduce the risk of ischemic and thromboembolic events but increase the risk of bleeding at the same time.The optimal antithrombotic regimen in patients with both CAD and AF has been controversial in clinical practice.In recent years,the expert consensuses on antithrombotic therapy in patients with AF presenting with acute coronary syndrome and/or undergoing percutaneous coronary intervention have been successively released in Europe and North America,and have been updated in a timely manner.In contrast,the guidelines on antithrombotic therapies in China are lacking.Based on published clinical evidence,this consensus incorporated relevant international and Chinese guidelines,consensuses,and expert recommendations,and addressed the issues encountered in the clinical practice of antithrombotic therapy in patients with AF and different types of CAD.The current guideline is of great significance to guide treatment in patients with both CAD and AF in China.展开更多
Microcirculatory dysfunction(CMD)typically occurs in patients with acute ST-segment elevation myocardial infarction during percutaneous coronary intervention,which is associated with more severe myocardial injury and ...Microcirculatory dysfunction(CMD)typically occurs in patients with acute ST-segment elevation myocardial infarction during percutaneous coronary intervention,which is associated with more severe myocardial injury and a worse prognosis.With the advancement of intracoronary physiology and imaging technology,the prevention and therapeutic interventions of CMD have attracted more attention.However,relevant guidelines or consensus on CMD are lacking in China.The current consensus summarizes the prevention and diagnostic strategies of emergency percutaneous coronary intervention-related CMD and gives suggestions to improve the prognosis of ST-segment elevation myocardial infarction patients based on evidence from recent clinical studies,guidelines,and consensus from international sources.展开更多
The coronary left main(LM)artery is characterized by large caliber,length varying from<8 to>15 mm,and 2 large daughter vessels branching from it;it supplies blood to a large area(>75%)of the myocardium.LM bif...The coronary left main(LM)artery is characterized by large caliber,length varying from<8 to>15 mm,and 2 large daughter vessels branching from it;it supplies blood to a large area(>75%)of the myocardium.LM bifurcation lesion is defined as the presence of atherosclerosis involving either or both of the 2 daughter vessels.Thus,the optimal strategy of revascularization for diseased LM has been an interesting research topic for a long time.With developments in percutaneous techniques,design,and materials of drug-eluting stents;intravascular imaging;new generation of antiplatelet medications;and particularly recent pooled evidence from randomized clinical trials comparing percutaneous coronary intervention with coronary artery bypass grafting,implantation of a drug-eluting stenting with or without other approved techniques is considered an important therapeutic approach for LM bifurcation lesions.Mirroring the anatomical complexity of the LM,stenting LM bifurcations is technically demanding,and intraprocedural complications can be catastrophic given the large amount of jeopardized myocardium.Therefore,the Chinese Society of Cardiology designed a writing committee with members from 3 working groups(ie,clinical research,intravascular imaging and physiology,and interventional cardiology)for the first time,to write a guideline on percutaneous treatment for LM bifurcation lesions,with view to improve the procedural quality and clinical outcomes.This guideline consists of introduction,anatomical description of the LM tree,risk stratification,strategies of revascularization,antiplatelet strategy,follow-up,and long-term management for patients with LM bifurcation lesions.展开更多
基金supported by the National Key Research and Development Projects(No.2018YFC1312502)to Shulin Wu。
文摘The coexistence of coronary artery disease(CAD)and atrial fibrillation(AF)is common in clinical practice.Patients with CAD require antiplatelet therapy to reduce the occurrence of myocardial ischemic events.However,patients with AF at high risk of thromboembolism require oral anticoagulants to reduce the occurrence of thromboembolic events such as stroke.In cases where CAD coexists with AF,the combined use of antiplatelet and anticoagulation therapy can effectively reduce the risk of ischemic and thromboembolic events but increase the risk of bleeding at the same time.The optimal antithrombotic regimen in patients with both CAD and AF has been controversial in clinical practice.In recent years,the expert consensuses on antithrombotic therapy in patients with AF presenting with acute coronary syndrome and/or undergoing percutaneous coronary intervention have been successively released in Europe and North America,and have been updated in a timely manner.In contrast,the guidelines on antithrombotic therapies in China are lacking.Based on published clinical evidence,this consensus incorporated relevant international and Chinese guidelines,consensuses,and expert recommendations,and addressed the issues encountered in the clinical practice of antithrombotic therapy in patients with AF and different types of CAD.The current guideline is of great significance to guide treatment in patients with both CAD and AF in China.
基金supported by the National Key Research and Development Projects(2022YFC3602400)the National Natural Science Foundation of China(92249301 and U22A6008).
文摘Microcirculatory dysfunction(CMD)typically occurs in patients with acute ST-segment elevation myocardial infarction during percutaneous coronary intervention,which is associated with more severe myocardial injury and a worse prognosis.With the advancement of intracoronary physiology and imaging technology,the prevention and therapeutic interventions of CMD have attracted more attention.However,relevant guidelines or consensus on CMD are lacking in China.The current consensus summarizes the prevention and diagnostic strategies of emergency percutaneous coronary intervention-related CMD and gives suggestions to improve the prognosis of ST-segment elevation myocardial infarction patients based on evidence from recent clinical studies,guidelines,and consensus from international sources.
文摘The coronary left main(LM)artery is characterized by large caliber,length varying from<8 to>15 mm,and 2 large daughter vessels branching from it;it supplies blood to a large area(>75%)of the myocardium.LM bifurcation lesion is defined as the presence of atherosclerosis involving either or both of the 2 daughter vessels.Thus,the optimal strategy of revascularization for diseased LM has been an interesting research topic for a long time.With developments in percutaneous techniques,design,and materials of drug-eluting stents;intravascular imaging;new generation of antiplatelet medications;and particularly recent pooled evidence from randomized clinical trials comparing percutaneous coronary intervention with coronary artery bypass grafting,implantation of a drug-eluting stenting with or without other approved techniques is considered an important therapeutic approach for LM bifurcation lesions.Mirroring the anatomical complexity of the LM,stenting LM bifurcations is technically demanding,and intraprocedural complications can be catastrophic given the large amount of jeopardized myocardium.Therefore,the Chinese Society of Cardiology designed a writing committee with members from 3 working groups(ie,clinical research,intravascular imaging and physiology,and interventional cardiology)for the first time,to write a guideline on percutaneous treatment for LM bifurcation lesions,with view to improve the procedural quality and clinical outcomes.This guideline consists of introduction,anatomical description of the LM tree,risk stratification,strategies of revascularization,antiplatelet strategy,follow-up,and long-term management for patients with LM bifurcation lesions.
