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Frequency, predictors, and prognosis of ejection fraction improvement in heart failure: an echocardiogram-based registry study 2019 ACC Expert Consensus Decision Pathway on Risk Assessment, Management, and Clinical Trajectory of Patients Hospitalized With Heart Failure: A Report of the American College of Cardiology Solution Set Oversight Committee Phenomapping for Novel Classification of Heart Failure With Preserved Ejection Fraction A three-vessel virtual histology intravascular ultrasound analysis of frequency and distribution of thin-cap fibroatheromas in patients with acute coronary syndrome or stable angina pectoris Stopping or continuing clopidogrel 12 months after drug-eluting stent placement: the OPTIDUAL randomized trial Myocardial bridging: contemporary understanding of pathophysiology with implications for diagnostic and therapeutic strategies The spectrum of heart failure: value of left ventricular ejection fraction and its moving trajectories DAPT, Our Genome and Clopidogrel Percutaneous coronary intervention versus coronary artery bypass grafting in patients with three-vessel or left main coronary artery disease: 10-year follow-up of the multicentre randomised controlled SYNTAX trial Evaluation and Management of Right-Sided Heart Failure: A Scientific Statement From the American Heart Association
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Review ArticleVolume 74, Issue 12, September 2019

JOURNAL：J Am Coll Cardiol. Article Link

From Early Pharmacology to Recent Pharmacology Interventions in Acute Coronary Syndromes

Szummer K, Jernberg T, Wallentin L. Keywords: ACS; antithrombotic treatment; clinical trials; MI; Non STEM; outcomes; PCI; reperfusion treatment; revascularization; STEMI

ABSTRACT

This focus seminar will take the reader through the history and pivotal trials that have formed the current state-of-the-art management for acute coronary syndromes. The identification of a ruptured plaque with thrombus formation and subsequent occlusion or downstream embolization in the coronary artery was the key to developing new and effective treatment strategies. The traditional wait-and-see approach with prolonged bedrest was replaced in the 1980s by immediate pharmacological reperfusion of the occluded coronary artery and long-term aspirin to prevent reinfarction. Mechanical reperfusion with percutaneous coronary intervention with stenting and more intense platelet inhibition with P2Y12 inhibitors further improved outcomes from early 2000s. Adjunctive treatment regimens, including anticoagulants, statins, and neurohormonal inhibition, were found to further reduce mortality and prevent new infarctions. Taken together, the use of new combined pharmacological and interventional treatment strategies has led to a remarkable decrease in 1-year mortality from around 22% in 1995 to around 11% by 2014.

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