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《2023 AHA/ACC/ACCP/ASPC/NLA/PCNA慢性冠状动脉疾病患者管理指南》要点解读

梁岩

梁岩. 《2023 AHA/ACC/ACCP/ASPC/NLA/PCNA慢性冠状动脉疾病患者管理指南》要点解读[J]. 协和医学杂志, 2024, 15(2): 312-319. doi: 10.12290/xhyxzz.2024-0043
引用本文: 梁岩. 《2023 AHA/ACC/ACCP/ASPC/NLA/PCNA慢性冠状动脉疾病患者管理指南》要点解读[J]. 协和医学杂志, 2024, 15(2): 312-319. doi: 10.12290/xhyxzz.2024-0043
LIANG Yan. Interpretation on the 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guidelines for the Management of Patients with Chronic Coronary Disease[J]. Medical Journal of Peking Union Medical College Hospital, 2024, 15(2): 312-319. doi: 10.12290/xhyxzz.2024-0043
Citation: LIANG Yan. Interpretation on the 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guidelines for the Management of Patients with Chronic Coronary Disease[J]. Medical Journal of Peking Union Medical College Hospital, 2024, 15(2): 312-319. doi: 10.12290/xhyxzz.2024-0043

《2023 AHA/ACC/ACCP/ASPC/NLA/PCNA慢性冠状动脉疾病患者管理指南》要点解读

doi: 10.12290/xhyxzz.2024-0043
基金项目: 

国家重点研发计划 2023YFC2413001

详细信息
    通讯作者:

    梁岩,E-mail:fwliangyan2016@163.com

  • 中图分类号: R541.4; R714.252

Interpretation on the 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guidelines for the Management of Patients with Chronic Coronary Disease

Funds: 

National Key R&D Program of China 2023YFC2413001

More Information
  • 摘要: 近期,美国心脏协会(American Heart Association,AHA)、美国心脏病学会(American College of Cardiology,ACC)等六大学会联合发布了《2023 AHA/ACC/ACCP/ASPC/NLA/PCNA慢性冠状动脉疾病患者管理指南》,该指南强调了“以患者为中心,以团队为基础”的总体管理理念和重视生活方式改善对慢性冠状动脉疾病患者预后的影响,并对主要心血管不良事件风险评估及新型药物推荐等作出了新的阐述,指南内容的更新对于指导我国临床医生为慢性冠状动脉疾病患者提供高质量管理具有重要指导意义。
    利益冲突:作者声明不存在利益冲突
  • 表  1  新版指南对于药物治疗预防心血管事件和症状管理的推荐意见

    Table  1.   The updated guidelines recommendations for pharmacological treatment in the prevention of cardiovascular events and management of symptoms

    推荐意见 推荐强度 证据等级
    对于同时患有高血压、糖尿病、LVEF≤40% 或CKD的CCD患者,建议使用ACEI或ARB(若ACEI不耐受)以减少CVD 1类推荐 A级证据
    对于同时患有高血压、糖尿病、LVEF>40% 或CKD的CCD患者,建议使用ACEI或ARB(若ACEI不耐受)以减少CVD 2b类推荐 B级证据
    对于CCD患者,可考虑添加秋水仙碱进行二级预防,以减少复发性ASCVD事件 2b类推荐 B级证据
    对于CCD患者,建议每年接种流感疫苗,以减少心血管发病率、心血管死亡率和全因死亡率 1类推荐 A级证据
    对于CCD患者,建议根据公共卫生指南接种COVID-19疫苗,以减少COVID-19并发症 1类推荐 C级证据
    对于CCD患者,肺炎球菌疫苗可合理降低心血管发病率和死亡率以及全因死亡率 2a类推荐 B级证据
    对于患有CCD和心绞痛的患者,建议使用β受体阻滞剂、CCB或长效硝酸盐进行抗心绞痛治疗,以缓解心绞痛或类似症状 1类推荐 B级证据
    对于初次治疗后仍有症状的CCD和心绞痛患者,建议添加不同治疗类别的第二种抗心绞痛药物(β受体阻滞剂、CCB、长效硝酸盐),以缓解心绞痛或类似症状 1类推荐 B级证据
    对于CCD患者,尽管使用β受体阻滞剂、CCB或长效硝酸酯疗法治疗,但症状仍存在的患者,建议使用雷诺嗪 1类推荐 B级证据
    对于CCD患者,建议舌下含服硝酸甘油或硝酸甘油喷雾剂,以立即短期缓解心绞痛或类似症状 1类推荐 B级证据
    对于CCD和左室功能正常的患者,在标准抗心绞痛治疗中添加伊伐布雷定,可能有害 3类推荐 B级证据
    对于患CCD、难治性心绞痛且无其他治疗选择的患者,可考虑增强体外反搏,以缓解症状 2b类推荐 B级证据
    LVEF(left ventricular ejection fractions):左心室射血分数;CKD(chronic kidney disease):慢性肾脏病;CCD(chronic coronary artery disease):慢性冠状动脉疾病;ACEI(angiotensin converting enzyme inhibitors):血管紧张素转化酶抑制剂;ARB(angiotensin receptor blocker):血管紧张素Ⅱ受体阻滞剂;ASCVD(atherosclerotic cardiovascular disease):动脉粥样硬化性心血管疾病;COVID-19(corona virus disease 2019):新型冠状病毒感染;CCB(calcium channel blocker):钙通道阻滞剂
    下载: 导出CSV

    表  2  新版指南关于CCD特殊人群管理的推荐意见

    Table  2.   The updated guidelines recommendations for the management of specific populations with CCD

    推荐意见 推荐强度 证据等级
    对于年轻的CCD患者,在优化传统心血管危险因素后,对非传统心血管危险因素进行综合评估和治疗,有利于降低CVD的发生风险 2a类推荐 C级证据
    对于患有CCD和癌症的患者,建议建立包括心脏病学和肿瘤学专业的多学科团队,以改善长期CVD结局 1类推荐 C级证据
    对于考虑怀孕或已怀孕的CCD患者,应对孕产妇、产科和胎儿不良结局的发生风险进行风险分层,并提供相关咨询 1类推荐 C级证据
    对于计划怀孕或已怀孕的CCD患者应在受孕前接受多学科心脏产科团队的护理,并持续整个孕期、分娩和产后,以改善母婴结局 1类推荐 C级证据
    对于女性CCD患者,可考虑怀孕期间继续使用他汀类药物 2b类推荐 C级证据
    对于女性CCD患者,不应接受全身绝经后激素治疗,因对MACE和死亡率无益处,且静脉血栓栓塞的风险增加 3类推荐 A级证据
    对于CCD和CKD患者,应采取措施尽量减少治疗相关的急性肾损伤发生风险 1类推荐 C级证据
    对于患有CCD和HIV感染的成年人,抗逆转录病毒治疗有助于降低CVD的发生风险 1类推荐 B级证据
    对于患有CCD和HIV感染的成年人,考虑药物相互作用,应选择有利于降低血脂和心血管风险状况的抗逆转录病毒治疗方案 2a类推荐 B级证据
    对于患有CCD和HIV感染的成年人,洛伐他汀或辛伐他汀不应与蛋白酶抑制剂共同服用,因其可能对患者造成伤害 3类推荐 C级证据
    对于患有CCD和类风湿关节炎的患者,若有替代疗法,则不建议长期使用大剂量糖皮质激素,因其增加心血管风险 3类推荐 C级证据
    对于心脏同种异体移植的血管病变患者,建议使用他汀类药物进行二级预防,以减少MACE 1类推荐 C级证据
    对于心脏同种异体移植的血管病变患者,阿司匹林有助于二级预防,减少MACE 2a类推荐 C级证据
    对于患有严重同种异体心脏移植血管病的患者,若具有合适的解剖结构,血运重建是合理的,其可潜在减轻同种异体心脏移植血管病的长期不良后果 2a类推荐 C级证据
    CCD、CKD: 同表 1;CVD(cardiovascular disease):心血管疾病;MACE(major adverse cardiovascular events):主要心血管不良事件;HIV(human immunodeficiency virus):人类免疫缺陷病毒
    下载: 导出CSV
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出版历程
  • 收稿日期:  2024-01-22
  • 录用日期:  2024-02-20
  • 网络出版日期:  2024-02-28
  • 刊出日期:  2024-03-30

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