《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:10.12114/j.issn.1007-9572.2023.0827

中国全科医学 ›› 2024, Vol. 27 ›› Issue (18): 2173-2178.DOI: 10.12114/j.issn.1007-9572.2023.0827

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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

薛亚男¹, 欧敏行², 张秀杰¹, 孟庆雪², 刘莹³^,^*()

1．116011　辽宁省大连市，大连医科大学附属第一医院心力衰竭与高血压科
2．116044　辽宁省大连市，大连医科大学
3．116011　辽宁省大连市，大连医科大学附属第一医院心力衰竭与结构性心脏病科

收稿日期:2023-11-15 修回日期:2024-01-10 出版日期:2024-06-20 发布日期:2024-03-22
通讯作者: 刘莹
作者贡献：
薛亚男负责文章的构思与设计、指南翻译、论文起草与修订；欧敏行负责指南翻译、绘制图表等；张秀杰负责翻译校对、监督管理；孟庆雪负责绘制图表与整理；刘莹负责论文修订、文章的质量控制及审校，对文章整体负责，监督管理。
基金资助:
国家自然科学基金重点项目(U1908209)

Interpretation of Key Points of 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients with Chronic Coronary Disease

XUE Yanan¹, OU Minxing², ZHANG Xiujie¹, MENG Qingxue², LIU Ying³^,^*()

1. Department of Heart Failure and Hypertension, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
2. Dalian Medical University, Dalian 116044, China
3. Department of Heart Failure and Structural Cardiology, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China

Received:2023-11-15 Revised:2024-01-10 Published:2024-06-20 Online:2024-03-22
Contact: LIU Ying

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摘要/Abstract

摘要： 慢性冠状动脉疾病是指因心脏流入或流出血流不足所引起的慢性心脏或血管疾病，发病率与死亡率居高不下，导致巨大的个人、经济与社会负担。2023年7月美国心脏协会（AHA）、美国心脏病学会（ACC）等6个学术组织联合发布了《2023 AHA/ACC/ACCP/ASPC/NLA/PCNA慢性冠状动脉疾病患者管理指南》，该指南提供了一种以循证为基础和以患者为中心的方法综合管理慢性冠状动脉疾病患者，内容涉及慢性冠状动脉疾病的流行病学，以及对患者的评估、诊断与风险分层、治疗、特殊人群管理，患者随访和相关注意事项等建议，强调了健康饮食、规律体育锻炼和远离烟草对心血管健康的重要性，并且更新了钠-葡萄糖协同转运蛋白2抑制剂和胰高血糖素样肽-1受体激动剂等药物的相关治疗推荐，为临床工作提供了最新的基于循证医学证据的建议。本文对该指南的管理策略进行要点解读，旨在为国内相关指南的制订与更新提供依据，不断规范与完善慢性冠状动脉疾病患者的专科诊疗照护，以期为临床实践提供循证指导，改善慢性冠状动脉疾病患者的预后。

关键词: 冠心病, 慢性冠状动脉疾病, 心血管疾病, 管理, 指南解读, 美国心脏协会

Abstract:

Chronic coronary disease (CCD) refers to chronic heart or vascular disease caused by insufficient blood flow into or out of the heart. The incidence and mortality rates of CCD are high, resulting in significant personal, economic, and societal burdens. In July 2023, the American Heart Association (AHA) and the American College of Cardiology (ACC), along with other academic organizations, jointly released the 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients with Chronic Coronary Disease. This guideline provides a on the evidence-based and patient-centered approach to comprehensive management of patients with CCD. It covers the epidemiology of CCD, patient assessment, diagnosis, risk stratification, treatment, management of special populations, patient follow-up, and related considerations. The guideline emphasizes the importance of a healthy diet, regular physical exercise, and tobacco avoidance for cardiovascular health. It also updates the recommendations for the use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) and provides the latest evidence-based recommendations for clinical practice. This article provides a key interpretation of the management strategies outlined in the guideline, aiming to provide a basis for the development and update of relevant guidelines in China. The goal is to standardize and improve the specialized diagnosis and care for patients with CCD, with the ultimate aim of providing evidence-based guidance for clinical practice and improving the prognosis of patients with CCD.

Key words: Coronary disease, Chronic coronary disease, Cardiovascular diseases, Management, Interpretation of guidelines, American Heart Association

薛亚男,欧敏行,张秀杰,等. 《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]. 中国全科医学, 2024, 27(18): 2173-2178. DOI: 10.12114/j.issn.1007-9572.2023.0827.
XUE Yanan,OU Minxing,ZHANG Xiujie, et al. Interpretation of Key Points of 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients with Chronic Coronary Disease[J]. Chinese General Practice, 2024, 27(18): 2173-2178. DOI: 10.12114/j.issn.1007-9572.2023.0827.

图/表 3

图1 CCD患者就诊时，临床医生需要考虑的领域注：SDOH=健康的社会决定因素。

Figure 1 Domains to consider when seeing a patient with CCD

图2 基于相互关联和沟通的团队合作方法

Figure 2 Team-based approach reflective of interconnectedness and communication

图3 营养推荐

Figure 3 Recommended nutrition

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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

Interpretation of Key Points of 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients with Chronic Coronary Disease

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