Chinese Guidelines for the Diagnosis and Management of Atrial Fibrillation

Atrial fibrillation(AF)is the most common sustained cardiac arrhythmia,significantly impacting patients’quality of life and increasing the risk of death,stroke,heart failure,and dementia.Over the past two decades,there have been significant breakthroughs in AF risk prediction and screening,stroke prevention,rhythm control,catheter ablation,and integrated management.During this period,the scale,quality,and experience of AF management in China have greatly improved,providing a solid foundation for the development of guidelines for the diagnosis and management of AF.To further promote standardized AF management,and apply new technologies and concepts to clinical practice in a timely and comprehensive manner,the Chinese Society of Cardiology of the Chinese Medical Association and the Heart Rhythm Committee of the Chinese Society of Biomedical Engineering have jointly developed the Chinese Guidelines for the Diagnosis and Management of Atrial Fibrillation.The guidelines have comprehensively elaborated on various aspects of AF management and proposed the CHA2DS2-VASc-60 stroke risk score based on the characteristics of AF in the Asian population.The guidelines have also reevaluated the clinical application of AF screening,emphasized the significance of early rhythm control,and highlighted the central role of catheter ablation in rhythm control.

Thirty-day outcomes of in-hospital multi-vessel versus culpritonly revascularization strategy for ST-segment elevation myocardial infarction with multivessel coronary disease

BACKGROUND Many studies have demonstrated the benefit of complete multivessel revascularization versus culprit-only intervention in patients of ST-segment elevation myocardial infarction(STEMI)and multivessel coronary artery disease.However,only a few single-center retrospective studies were performed on small Chinese cohorts.Our study aims to demonstrate the advantage of multivessel percutaneous intervention(PCI)strategy on 30-day in-hospital outcomes to patients with STEMI and multivessel disease in larger Chinese population.METHODS From the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome(CCC-ACS)project,5935 patients with STEMI and multivessel disease undergoing PCI and hospitalized for fewer than 30 days were analyzed.After 5:1 propensity score matching,3577 patients with culprit-only PCI and 877 with in-hospital multivessel PCI were included.The primary outcome was major adverse cardiovascular and cerebrovascular event(MACCE),defined as a composite of myocardial infarction,all-cause death,stent thrombosis,heart failure,and stroke.RESULTS Multivariable logistic regression analysis revealed that in-hospital multivessel PCI was associated with lower risk of 30-day MACCE(adjusted OR=0.75,95%CI:0.57-0.98,P=0.032)than culprit-only PCI and conferred no increased risk of allcause death,myocardial infarction,stent thrombosis,stroke,or bleeding.Subgroup analysis showed that MACCE reduction was observed more often from patients with trans-femoral access(OR=0.34,95%CI:0.15-0.74)than with trans-radial access(OR=0.87,95%CI:0.66-1.16,P for interaction=0.017).CONCLUSIONS The in-hospital multivessel PCI strategy was associated with a lower risk of 30-day MACCE than culprit-only PCI in patients with STEMI and multivessel coronary artery disease.

Prolonging dual antiplatelet therapy improves the long-term prognosis in patients with diabetes mellitus undergoing complex percutaneous coronary intervention

OBJECTIVE To investigate the optimal duration of dual antiplatelet therapy(DAPT)in patients with diabetes mellitus(DM)requiring complex percutaneous coronary intervention(PCI).METHODS A total of 2403 patients with DM who underwent complex PCI from January to December 2013 were consecutively enrolled in this observational cohort study and divided according to DAPT duration into a standard group(11-13 months,n=689)and two prolonged groups(13-24 months,n=1133;>24 months,n=581).RESULTS Baseline characteristics,angiographic findings,and complexity of PCI were comparable regardless of DAPT duration.The incidence of major adverse cardiac and cerebrovascular event was lower when DAPT was 13-24 months than when it was 11-13 months or>24 months(4.6%vs.8.1%vs.6.0%,P=0.008),as was the incidence of all-cause death(1.9%vs.4.6%vs.2.2%,P=0.002)and cardiac death(1.0%vs.3.0%vs.1.2%,P=0.002).After adjustment for confounders,DAPT for 13-24 months was associated with a lower risk of major adverse cardiac and cerebrovascular event[hazard ratio(HR)=0.544,95%CI:0.373-0.795]and all-cause death(HR=0.605,95%CI:0.387-0.944).DAPT for>24 months was associated with a lower risk of all-cause death(HR=0.681,95%CI:0.493-0.942)and cardiac death(HR=0.620,95%CI:0.403-0.952).The risk of major bleeding was not increased by prolonging DAPT to 13-24 months(HR=1.356,95%CI:0.766-2.401)or>24 months(HR=0.967,95%CI:0.682-1.371).CONCLUSIONS For patients with DM undergoing complex PCI,prolonging DAPT might improve the long-term prognosis by reducing the risk of adverse ischemic events without increasing the bleeding risk.

Cardioprotective effects of Guanxinshutong （GXST） against myocardial ischemia/ reperfusion injury in rats

对 cardioprotective 药的灌注损害的 BackgroundThe 保护的效果最近被评估了并且发现了不适当。Guanxinshutong (GXST ) ，传统的植物的联合和蒙古的药，在在临床的试用对待心绞痛有效、安全。我们在老鼠对心肌的局部缺血和灌注(MI/R ) 损害估计 GXST 的 cardioprotective 效果并且探索它的可能的 mechanism.MethodsForty -- 五只男 Sprague Dawley 老鼠被使随机化进三个组：non-MI/R 组(假冒， n = 15 ) ，与车辆对待的 MI/R 组(控制， n = 15 ) 并且与 GXST 对待的 MI/R 组(药， n = 15 ) 。MI/R 被左前面的下降冠的动脉(男孩) 的结扎导致 30 分钟，在控制和药组由 2/24 小时灌注列在后面。在假冒的组，没有吸藏， LAD 被暴露。GXST 粉末(在药组) 或盐(在控制和假冒的组) 在外科以前从 7 白天经由直接胃的 gavage 被管理。血样品从颈动脉动脉被收集(10 只老鼠各组织) 在 2 小时灌注以后，决定肿瘤坏死 factor-&#x003b1 的层次；(TNF-&#x003b1；) ， interleukin-1&#x003b2；(IL-1&#x003b2；) ， interleukin-6 (IL-6 ) 和用连接酶的 immunosorbent 试金的细胞间的粘附 molecule-1 (ICAM-1 ) 。动物然后被牺牲，心为组织病理学说和西方的污点分析被收获。梗塞尺寸在留下被测量在在 24 小时 reperfusion.ResultsGXST 以后的每个组的五只老鼠显著地减少了 TNF-&#x003b1 的层次；， IL-1&#x003b2；， IL-6， ICAM-1， apoptosis 索引(AI ) 和梗塞缩放。GXST 显然也禁止了原子因素 kappa B (NF-&#x003ba； B ) 活动什么时候与控制组相比(所有 P &#x0003c；0.05 ).ConclusionsGXST 在在老鼠保护心肌层免于 MI/R 损害是有效的。它的可能的 cardioprotective 机制包含煽动性的反应和 apoptosis 追随者 MI/R 损害的抑制。

Efficacy and safety of individually tailored antiplatelet therapy in patients with acute coronary syndrome after coronary stenting： a single center, randomized, feasibility study

到 clopidogrel (纵向冗余码校验) 的 BackgroundLow 应答与 ischemic 事件的增加的风险被联系。这研究被瞄准根据应答探索定制的 antiplatelet 治疗的可行性到 305 clopidogrel na&#x000ef 全部的 clopidogrel.MethodsA；有经历冠的 stenting 的急性冠的症候群(交流) 的 ve 病人随机被分配收到标准(n = 151 ) 或定制(n = 154 ) antiplatelet 治疗。由轻传播 aggregometry 的导致自动数据处理的血小板聚集测试被执行识别分到定制的组的纵向冗余码校验病人。标准 antiplatelet 政体是有阿司匹林和 clopidogrel 的双 antiplatelet 治疗。定制的 antiplatelet 治疗为纵向冗余码校验病人是为非纵向冗余码校验病人和另外的 6 月的 cilostazol 治疗的标准政体。主要功效结果是在一 year.ResultsLCR 的心血管的死亡，心肌的梗塞或击合成在 26.6% 是在场的(41/154 ) 在定制的组的病人。为 LCR 病人的百分比血小板聚集显著地在附属 cilostazol 治疗以后在三天被减少(77.5%&#x000b1；12.1% 对 64.5%&#x000b1；12.1% ， P &#x0003c；0.001 ) 。在一年后续，一不重要主要事件的 37% 相对风险减小作为与标准组相比在定制的组被观察(5.8% 对 9.3% ， P = 0.257 ) 。在冠的 stenting 根据到 clopidogrel 的应答是可行的以后，处于在为交流病人的二 groups.ConclusionsTailored antiplatelet 治疗之间的 stent 血栓和出血性的事件的率没有差别。然而，它的功效和安全需要与更大的样品尺寸由临床的试用推进证实。

Efficacy and safety of fondaparinux versus enoxaparin in patients undergoing percutaneous coronary intervention treated with the glycoprotein IIb/IIIa inhibitor tirofiban

Background: In worldwide, the mortality rate of acute myocardial infarction(AMI) raises year by year. Although the applications of percutaneous coronary intervention(PCI) and anticoagulants effectively reduce the mortality of patients with acute coronary syndrome(ACS), but also increase the incidence of bleeding. Therefore, drugs with stable anticoagulant effects are urgently required.Methods: We enrolled 894 patients with acute coronary syndrome who underwent percutaneous coronary intervention in Shenyang Northern Hospital from February 2010 to May 2012; 430 patients were included in the fondaparinux group(2.5mg/d), and 464 were included in the enoxaparin group(1mg/kg twice daily). Fondaparinux and enoxaparin were applied for 3–7 days. All patients were treated with tirofiban [10μg/kg for 3min initially and 0.15μg/(kg·min) for 1 to 3 days thereafter]. The primary efficacy endpoint was the incidence of a major adverse cerebrovascular or cardiovascular event. The primary safety endpoint was bleeding within 30 days and 1 year after percutaneous coronary intervention.Results: One-year data were available for 422 patients in the fondaparinux group and for 453 in the enoxaparin group. The incidence of a major adverse cerebrovascular or cardiovascular event(10.9% vs 12.6%, P=0.433) and cardiac mortality(0.5% vs 1.5%, P=0.116) were generally lower in the fondaparinux group than in the enoxaparin group, although the differences were not significant. Compared with the enoxaparin group, the fondaparinux group had a significantly decreased rate of bleeding at 30 days(0.9% vs 2.9%, P=0.040) and 1 year(2.4% vs 5.5%, P=0.018). In addition, the rate of major bleeding events was lower in the fondaparinux group, but this difference was not significant(0.2% vs 0.9%, 0.2% vs 1.1%).Conclusion: In tirofiban-treated patients with acute coronary syndrome undergoing percutaneous coronary intervention, fondaparinux presented similar efficacy for ischemia events as enoxaparin. However, fondaparinux significantly decreased the incidence of bleeding, thus providing safer anticoagulation therapy.

Staged versus ＂one-time＂ multivessel intervention in elderly patients with non-ST-elevation acute coronary syndrome

评估一次性对上演的 multivessel stenting 的临床的结果在老( 60 年)有 non-ST-elevation 的病人急性冠的症候群(NSTE交流)和 multivessel 疾病( MVD ) .MethodsWe 与 multivessel 分析了连续NSTE交流病人的数据经皮的冠的干预(一种总线标准)在沈阳军人的医院将军被注册在 2008 和 2012 之间的区域。60 的 1090 个合格病人的一个总数进一步被分成一次性的组(n = 623 ) 并且上演一种总线标准组(n = 467 ) 根据干预策略。主要端点是心肌的梗塞(MI ) 的合成结果或心脏的死亡在 3 年的 follow-up.ResultsThe 期间估计了心脏的死亡的 3 年的合成的率或 MI 在上演一种总线标准组是 7.0% 并且 9.5% 在一次性的组(P = 0.110 ) 。Multivariate 分析在主要事件上证实了上演一种总线标准的利益在老(HR：0.638， 95% CI：0.408-0.998， P = 0.049 ) 。在倾向， 20 匹配队，上演一种总线标准与主要事件的更低的率被联系(6.1% 对 10.4% ， P = 0.046 ) 并且 MI (3.4% 对 7.4% ， P = 0.037 ) 在三年。另外，在在 30 天的 stent 血栓有减少的趋势(0.3% 对 1.4% ， P = 0.177 ) 并且在三年(1.1% 对 2.4% ， P = 0.199 ) 在上演一种总线标准组。在 3 年的目标容器 revascularization 没有重要差别(15.5% 对 14.4% ， P = 0.746 ).ConclusionsIn 有 MVD 的老 NSTE 交流病人，上演一种总线标准可能是与一次性的一种总线标准策略相比与减少的长期的心脏的死亡或 MI 联系的最佳的策略，它需要进一步的证实。

Predictors of contrast-induced acute kidney injury in patients with coronary artery disease receiving contrast agents twice within 30 days

Background:None of study mentioned about contrast-induced acute kidney injury(CI-AKI)in people who have received contrast agents twice within in a short period of time.This study is trying to identify the predictors.Methods:We enrolled 607 patients between Oct.2010 and Jul.2015 who received contrast agents twice within 30 days in the Department of Cardiology of the General Hospital of Shenyang Military Region.The primary outcome was CI-AKI within 72 h after contrast agent exposure.Patients were divided into groups A(n=559)and group B(n=48)according to whether CI-AKI occurred after the second agent.Results:Patients in group B(CI-AKI occurred after the second agent)had a more rapid heart rate and more usage of diuretics and digitalis.In group B,CI-AKI occurred more frequently after the first agent.Multivariate logistic regression showed that diuretic(P=0.006)and intra-aortic balloon pump(IABP)usage(P=0.012)were independent predictors of CI-AKI after the first agent.Angiotensin-converting enzyme inhibitor/AngiotensinⅡreceptor antagonist(ACEI/ARB)usage(P=0.039),IABP usage(P=0.040)and CI-AKI occurring after administration of the first agent(P=0.015)were independent predictors of CI-AKI after the second.Furthermore,dividing the patients into tertiles of the time interval between the two agents showed that CI-AKI occurred more frequently when the second agent was administered within 1–3 days after the first exposure than within 4–6 days(12.4%vs.5.0%,P=0.008)or≥7 days(12.4%vs.6.4%,P=0.039).Conclusions:Diuretic and IABP usage are independent predictors of CI-AKI following exposure to a first contrast agent.The major predictors of CI-AKI after exposure to a second agent are time since the first contrast exposure,ACEI/ARB usage,and IABP usage.More importantly,a three-day interval between the two agents is associated with a higher incidence of CI-AKI following the second administration.

The impacts of different embolization techniques on splenic artery embolization for blunt splenic injury: a systematic review and meta-analysis

Background: Splenic artery embolization(SAE) has been an effective adjunct to the Non-operative management(NOM) for blunt splenic injury(BSI). However, the optimal embolization techniques are still inconclusive. To further understand the roles of different embolization locations and embolic materials in SAE, we conducted this system review and meta-analyses.Methods: Clinical studies related to SAE for adult patients were researched in electronic databases, included Pub Med, Embase, Science Direct and Google Scholar Search(between October 1991 and March 2013), and relevant information was extracted. To eliminate the heterogeneity, a sensitivity analysis was conducted on two reduced study sets. Then, the pooled outcomes were compared and the quality assessments were performed using Newcastle-Ottawa Scale(NOS). The SAE success rate, incidences of life-threatening complications of different embolization techniques were compared by χ2 test in 1 st study set. Associations between different embolization techniques and clinical outcomes were evaluated by fixed-effects model in 2 nd study set.Results: Twenty-three studies were included in 1 st study set. And then, 13 of them were excluded, because lack of the necessary details of SAE. The remaining 10 studies comprised 2 nd study set, and quality assessments were performed using NOS. In 1 st set, the primary success rate is 90.1% and the incidence of life-threatening complications is 20.4%, though the cases which required surgical intervention are very few(6.4%). For different embolization locations, there was no obvious association between primary success rate and embolization location in both 1 st and 2 nd study sets(P >0.05). But in 2 nd study set, it indicated that proximal embolization reduced severe complications and complications needed surgical management. As for the embolic materials, the success rate between coil and gelfoam is not significant. However, coil is associated with a lower risk of life-threatening complications, as well as less complications requiring surgical management.Conclusion: Different embolization techniques affect the clinical outcomes of SAE. The proximal embolization is the best option due to the less life-threatening complications. For commonly embolic material, coil is superior to gelfoam for fewer severe complications and less further surgery management.

Analysis of risk factors for early stent thrombosis in the Chinese population:A multicenter restrospective study

BACKGROUND:The predictive scoring systems for early stent thrombosis(EST)remains blank in China.The study aims to evaluate the risk factors and conduct a prediction model of EST in the Chinese population.METHODS:EST was defined as thrombosis that occurs within the first 30 days after primary percutaneous coronary intervention(PCI).Patients from ten Chinese hospitals diagnosed as stent thrombosis(ST)from January 2010 to December 2016 were retrospectively included as the study group.A control group(1 case:2 controls)was created by including patients without ST,major adverse cardiovascular events,or cerebrovascular events during follow-up.The present study evaluated 426 patients with single-vessel lesions and ultimately included 40 patients with EST and 80 control patients,who were included to identify factors that predicted EST and to develop a prediction scoring system.The other 171 patients without integrated 1:2 pair were used for external validation.RESULTS:EST was independently associated with a low hemoglobin concentration(adjusted odds ratio[OR]0.946,95%confi dence interval[95%CI]0.901-0.993,P=0.026),a high pre-PCI Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery(SYNTAX)score(OR 1.166,95%CI 1.049-1.297,P=0.004),and a DAPT(DAPT)duration of<30 days(OR 28.033,95%CI 5.302-272.834,P<0.001).The simple EST prediction score provided an area under the curve(AUC)of 0.854(95%CI 0.777-0.932,P<0.001)with 70.0%sensitivity and 90.0%specifi city,and 0.742(95%CI 0.649-0.835,P<0.001)with 54.5%sensitivity and 81.0%specifi city for external validation dataset.CONCLUSIONS:EST may be independently associated with DAPT discontinuation within 30 days,a low hemoglobin concentration,and a high SYNTAX score.The scoring system also has a good ability to predict the risk of EST and may be useful in the clinical setting.

Scientific statement of the Chinese Society of Cardiology(CSC) on using of renin angiotensin system blockers in patients with cardiovascular disease and COVID-19

The coronavirus disease 2019(COVID-19), which is caused by SARS-CoV-2, has become a worldwide public health crisis. Published clinical data from China and other countries have shown a much higher risk of developing COVID-19 and dying from the disease among the elderly, especially among those who had preexisting hypertension, cardiovascular diseases(CVD) and diabetes mellitus[1].

Endovascular stent-graft for type B aortic dissection in elderly patients

在老病人为类型 B 大动脉的解剖报导 endovascular stent接枝治疗的临床的结果和复杂并发症的目的作为与在到2008年7月的从2002年5月的单个医药 center.Methods 的更年轻的病人相比， endovascular stent-grafi 培植在心病学的部门与类型 B 大动脉的解剖在 124 个病人被执行，沈阳北 Hospital.Among 他们， 39 个病人是 60 岁以上(从 68～81 年 )当 85 个病人比 60 年轻时木头等级， P=0.31 ) 在 2 groups.Conclusions Endovascular stent 接枝之间，培植在为老、更年轻的 patients.The 的类型 B 大动脉的解剖的治疗安全、有效过程相关的复杂并发症率似乎独立于年龄。

Long-term follow-up of antithrombotic management patterns in patients with acute coronary syndrome in China

Objective To describe the long-term antithrombotic management patterns(AMPs)and clinical outcomes of Chinese patients with acute coronary syndrome(ACS).Methods This was an observational,multicenter,longitudinal cohort extension study of Chinese patients who had completed the EPICOR Asia 2-year follow-up study post-hospitalization for an ACS event.Changes in AMP and clinical outcomes for up to 5 years post-ACS event were evaluated.Results Overall,2334 patients with ACS were enrolled at 49 sites.The mean age was 61.6 years and 76.3%were men.By study end,2093 patients completed the 3-year follow-up.At baseline(2 years post-ACS event),72.4%of patents received one antiplatelet(AP)medication,with aspirin being the preferred one.A small proportion of patients(21.5%)was treated with two or more APs(2+AP),and even fewer patients(6.1%)did not receive any AP medication at baseline.Upon study completion,the proportion of patients without AP therapy increased to 13.6%,while the percentage of patients on one AP and 2+AP decreased to 69.3%and 17.1%,respectively.Numerically,a higher incidence of clinical events(composite of all-cause mortality,myocardial infarction,stroke)was observed for the 2+AP(13.2%)subgroup than for the no AP(10.5%)and one AP(8.6%)subgroups.Furthermore,the 2+AP subgroup exhibited the greatest number of bleeding events,outpatient visits,and hospitalization rates.Unlike myocardial infarction or stroke,bleeding events prompted an adjustment in AMP.Conclusion Most patients in China received at least one AP medication up to 5 years after an ACS event.

PR-segment depression during cryoballoon ablation of atrial fibrillation: a case report

Cryoballoon ablation has been widely used in the treatment of atrial fibrillation (AF).[1] The main complications of the procedure include pericardial tamponade, pulmonary vein stenosis, and atrial esophageal leakage, etc.[2] But there has been hardly any reporting of PR-segment changes caused by cryoballoon ablation of AF.

Feasibility study of emergency intervention for vascular injury outside the hospital

Background: Minimally invasive surgery in the field of traumatic vascular injury diagnosis and treatment has achieved good results. This study was designed to determine whether pre-hospital emergency intervention is feasible for vascular injury in a field intervention cabin under the condition of war or a disaster site.Methods: Different types of animal experiments of vascular injury intervention were performed in a field intervention cabin. Treatment capacity was evaluated by data collection, including duration of surgery, clinical evaluation, image clarity, and equipment handling. Environmental adaptability and mobility were evaluated by maneuverability and long-distance mobility.Results: A total of 56 surgeries(7 types) were performed in the field intervention cabin. Digital subtraction angiography(DSA) had good imaging performance. A total of 4800 km of long-distance mobility was performed, and all the equipment operated normally without any equipment failure. We participated in the medical service maneuver twice. The cabin unfolded and worked properly. There was no equipment damage during the medical service maneuver.Conclusion: Use of a field intervention cabin under the conditions of war or disaster is feasible for pre-hospital emergency intervention of vascular injury.

Comparing of Light Transmittance Aggregometry and Modified Thrombelastograph in Predicting Clinical Outcomes in Chinese Patients Undergoing Coronary Stenting with Clopidogrel

Background： Several platelet function tests are currently used to measure responsiveness to antiplatelet therapy. This study was to compare two tests, light transmittance aggregometry （LTA） and modified thrombelastography （mTEG）, for predicting clinical outcomes in Chinese patients after percutaneous coronary intervention （PCI）. Methods： Prospective, observational, single-center study of 789 Chinese patients undergoing PCI was enrolled. This study was investigated the correlations between the two tests and performed receiver operating characteristic curve （ROC） analysis for major adverse cardiovascular events （MACEs） at 1-year follow-up. Results： MACEs occurred in 32 patients （4.1%）. Correlations were well between the two tests in the adenosine diphosphate induced platelet reactivity （Spearman r = 0.733, P 〈 0.001 ）. ROC-curve analysis demonstrated that LTA （area under the curve [AUC]： 0.677; 95% confidence interval [CO： 0.643-0.710; P = 0.0009）, and mTEG （AUC： 0.684; 95% CI： 0.650-0.716; P = 0.0001） had moderate ability to discriminate between patients with and without MACE. MACE occurred more frequently in patients with high on-treatment platelet reactivity （HPR） when assessed by LTA （7.4% vs. 2.7%; P 〈 0.001）, and by TEG （6.7% vs. 2.6%; P 〈 0.001 ）. Kaplan-Meier analysis demonstrated that HPR based on the LTA and mTEG was associated with almost 3-fold increased risk of MACE at 1-year follow-up. Conclusions： The correlation between LTA and mTEG is relatively high in Chinese patients. HPR measured by LTA and mTEG were significantly associated with MACE in Chinese patients undergoing PCI.

De-escalation of anti-platelet therapy in patients with acute coronary syndromes undergoing percutaneous coronary intervention: a narrative review

Objective:Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor inhibitor is the cornerstone of treatment in patients with acute coronary syndromes (ACS) and in those undergoing percutaneous coronary intervention (PCI).In current clinical situation, availability of different oral P2Y12 inhibitors (clopidogrel, prasugrel, and ticagrelor) has enabled physicians to switch among therapies owing to specific clinical scenarios.Although optimum time, loading dose and interval of transition between P2Y12 inhibitors is still controversial and needs further evidence, switching between oral inhibitors frequently occurs in clinical practice for several reasons.Data sources:This review was based on data in articles published in PubMed up to June 2018, with the following keywords "antiplatelet therapy" , "ACS" , "PCI" , "ticagrelor" and "clopidogrel" .Study selection:Original articles and critical reviews on de-escalation strategy in ACS patients after PCI were selected.References of the retrieved articles were also screened to search for potentially relevant papers.Results:Safety concerns associated with switching between antiplatelet agents, has prompted the use of clopidogrel for patients with ACS especially after PCI as a de-escalation strategy.Practical considerations for de-escalating therapies in patients with ACS such as reducing dose of P2Y12 inhibitors or shortening duration of DAPT (followed by aspirin or P2Y12 receptor inhibitor monotherapy) as potential options are yet to be standardized and validated.Conclusions:Current review will provide an overview of the pharmacology of common P2Y12 inhibitors, definitions of deescalation and different de-escalating strategies and its outcomes, along with possible direction to be explored in de-escalation.