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Angiography Alone Versus Angiography Plus Optical Coherence Tomography to Guide Percutaneous Coronary Intervention Outcomes From the Pan-London PCI Cohort The Relation Between Optical Coherence Tomography-Detected Layered Pattern and Acute Side Branch Occlusion After Provisional Stenting of Coronary Bifurcation Lesions Optical coherence tomography versus intravascular ultrasound to evaluate coronary artery disease and percutaneous coronary intervention Spontaneous Coronary Artery Dissection: Pathophysiological Insights From Optical Coherence Tomography Clinical Impact of Suboptimal Stenting and Residual Intrastent Plaque/Thrombus Protrusion in Patients With Acute Coronary Syndrome: The CLI-OPCI ACS Substudy (Centro per la Lotta Contro L'Infarto-Optimization of Percutaneous Coronary Intervention in Acute Coronary Syndrome) Exercise unmasks distinct pathophysiologic features in heart failure with preserved ejection fraction and pulmonary vascular disease Technical aspects of the culotte technique Lipid-rich plaque and myocardial perfusion after successful stenting in patients with non-ST-segment elevation acute coronary syndrome: an optical coherence tomography study Noninvasive Screening for Pulmonary Hypertension by Exercise Testing in Congenital Heart Disease Characteristics of abnormal post-stent optical coherence tomography findings in hemodialysis patients

Original Research2018 Jun 12;137(24):2551-2553.

JOURNAL: Article Link

Conceptual Framework for Addressing Residual Atherosclerotic Cardiovascular Disease Risk in the Era of Precision Medicine

Patel KV, Pandey A, de Lemos JA et al. Keywords: atherosclerosis; biomarkers; precision medicine; residual risk; secondary prevention

ABSTRACT

Until recently, therapies to mitigate atherosclerotic cardiovascular disease (ASCVD) risk have been limited to lifestyle interventions, blood pressure-lowering medications, high-intensity statin therapy, antiplatelet agents, and, in select patients, coronary artery revascularization. Despite administration of these evidence-based therapies, substantial residual risk for cardiovascular events persists, particularly among individuals with known ASCVD. Moreover, the current guideline-based approach does not adequately account for patient-specific, causal pathways that lead to ASCVD progression and complications. In the past few years, multiple new pharmacological agents, targeting conceptually distinct pathophysiological targets, have been shown in large and well-conducted clinical trials to lower cardiovascular risk among patients with established ASCVD receiving guideline-directed medical care. These evidenced-based therapies reduce event rates and, in some cases, all-cause and cardiovascular mortality; these benefits confirm important new disease targets and challenge the adequacy of the current standard of care for secondary prevention.

After years of treating our patients after an acute coronary syndrome event with the same core group of medications that have been proven to be safe, beneficial, and cost-effective, a diverse array of potentially beneficial options to address residual risk is now available. The near simultaneous development of these new approaches to secondary prevention disrupts existing paradigms regarding assessment and treatment of residual risk. For example, consider a hypothetical patient with obesity, hypertension, type 2 diabetes mellitus, and hyperlipidemia who had a non-ST elevation myocardial infarction and received an intracoronary drug-eluting stent. This patient would likely be …

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