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    Advances in Intensified Antithrombotic Therapies in Acute Coronary Syndrome
    DENG Tianhua, HUANG Lin, YOU Zhigang
    Chinese General Practice    2023, 26 (09): 1131-1135.   DOI: 10.12114/j.issn.1007-9572.2022.0444
    Abstract650)   HTML20)    PDF(pc) (1348KB)(210)       Save

    Acute coronary syndrome (ACS) is a serious coronary heart disease with relatively high mortality, and a history of ACS is associated with subsequent risk of recurrent ischemic events such as ischemic stroke and myocardial infarction. Platelet aggregation and thrombus formation are considered as indispensable factors that lead to ACS. To reduce the residual ischemic risk, it is clinically recommended that patients with ACS receive dual antiplatelet therapy with aspirin combined with a potent P2Y12 inhibitor for 12 months, but this therapy has been proven to be unsatisfactory in controlling the risk. More studies are ongoing to explore intensified antithrombotic therapies to reduce the risk of recurrent ischemic events. In this paper, the mechanisms of actions of and advances in intensified antithrombotic therapies in ACS were reviewed, and it is found that the risk of ischemic events can be further reduced by extended-term dual antiplatelet therapy, triple antiplatelet therapy and dual pathway inhibition therapy (namely antiplatelet therapy combined with anticoagulant therapy) . This review will help to the implementation of clinical individualized antithrombotic therapy and the choice of the best antithrombotic strategy.

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    Hybrid Ablation: a Future Development Trend in the Management of Atrial Fibrillation
    ZHANG Ning, HOU Ming, MEI Bo, JIN Weitao, TAN Xiong, YANG Mingchuan, WANG Liang, LIU Yong, LAI Yinglong
    Chinese General Practice    2023, 26 (09): 1136-1145.   DOI: 10.12114/j.issn.1007-9572.2022.0760
    Abstract633)   HTML21)    PDF(pc) (2432KB)(314)       Save

    As the most common type of arrhythmia, atrial fibrillation has proven to be associated with serious adverse cardiovascular and cerebrovascular events, such as heart failure, stroke and myocardial infarction. The global number of patients with atrial fibrillation has exceeded 33 million, and it is estimated to be more than doubled in the next 40 years. Although years of efforts have been made to the research on pathophysiological mechanism, and the exploration of new treatments and improvement of treatments regarding atrial fibrillation, the management of atrial fibrillation is still a difficult problem in clinical medicine, and there is no consensus on the best treatment and the choice of energy source for ablation in atrial fibrillation with the increasing advances made in surgical and catheter ablative techniques. Catheter ablation often requires multiple operations with unsatisfactory success rate and surgical ablation is often associated with high risk of postoperative adverse events. Hybrid ablation, a new treatment recently developed by the joint efforts of cardiac surgeons and electrophysiologists, integrates the merits of catheter ablation and minimally invasive surgical ablation but overcomes the limitations of the two, has proven to be effective in reducing the risk of postoperative adverse outcomes, and considerably efficacious in treating persistent atrial fibrillation, especially long-term persistent atrial fibrillation. We reviewed the advances in atrial fibrillation ablation, and comparatively analyzed existing studies of hybrid ablation, and summarized the advantages and challenges of this treatment, hoping to provide one more option for clinical treatment of atrial fibrillation.

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    Effect of Epicardial Adipose Tissue on In-stent Restenosis after Percutaneous Coronary Intervention: a Review
    AN Jingjing, WANG Xiaojuan, DENG Aiyun
    Chinese General Practice    2023, 26 (09): 1146-1150.   DOI: 10.12114/j.issn.1007-9572.2022.0453
    Abstract652)   HTML15)    PDF(pc) (1559KB)(256)       Save

    As a major treatment for coronary artery disease, percutaneous coronary intervention (PCI) effectively enhances the survival rate of patients. However, the post-PCI in-stent restenosis has become a new cardiovascular problem that is difficult to solve. Inflammation and endothelial dysfunction, as the initiating inducing factors of in-stent restenosis, together with subsequently developed neointimal thickening and neoatherosclerosis based on which, promote the progression of in-stent restenosis. Inflammatory markers secreted by epicardial adipose tissue may directly influence the function of coronary vascular endothelial cells, smooth muscle cells and macrophages, disrupting the homeostasis of the coronary vessel wall, thereby being involved in the pathophysiological process of in-stent restenosis after coronary stenting. In addition, multiple clinical studies have shown that epicardial adipose tissue could partially predict in-stent restenosis in patients with coronary artery disease within 1 year after PCI. We reviewed the latest advances in the effect of epicardial adipose tissue on in-stent restenosis after PCI, and clinical prediction of post-PCI in-stent restenosis by epicardial fat, as well as treatment for post-PCI in-stent restenosis, providing a new idea for the prevention and treatment of post-PCI in-stent restenosis.

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