心肌缺血综合征:一个新的命名法来协调不断变化的国际临床实践指南
William E Boden1, Raffaele De Caterina1, Juan Carlos Kaski2
1VA Boston Healthcare System, Boston University School of Medicine, Boston, MA (W.E.B.).
Circulation
|August 30, 2024
概括
建议使用心肌缺血综合征的新术语来统一分类并改善患者护理. 这旨在涵盖阻塞性和非阻塞性原因,加强对心痛和心脏病发作的诊断和治疗策略.
科学领域:
- 心脏病学
- 医学术语
- 心脏缺血性疾病
背景情况:
- 目前对心肌缺血的分类缺乏一致性,使用"稳定冠状动脉疾病" (CAD),"稳定缺血性心脏病"和"慢性冠状动脉综合征" (CCS) 等术语.
- 相互矛盾的指导方针 (欧洲与美国) 和限制性的术语使得CAD的看法狭窄,往往忽视了非阻碍性机制.
- 现有的分类未能全面解决心肌痛和心肌缺血的各种原因,阻碍了概念的清晰和统一的管理.
研究的目的:
- 为心肌缺血综合征提出一个新的,包容性的二元分类.
- 推进术语,包括阻塞性和非阻塞性缺血原因,包括微血管功能障碍和血管动性疾病.
- 为了改善诊断和治疗方法,在国际指导方针中协调不一致的命名法.
主要方法:
- 对急性心肌梗塞 (MI) 和慢性稳定性心肌缺血现有分类系统的审查和分析.
- 开发一种新的二元分类:"急性心肌缺血综合征"和"非急性心肌缺血综合征".
- 将已知类别 (例如ACS,STEMI,NSTEMI) 和新兴概念 (例如非阻塞性冠状动脉的MI) 纳入拟议的框架.
主要成果:
- 建议对"急性心肌缺血综合征"和"非急性心肌缺血综合征"进行二元分类.
- 新的分类包括阻塞性表心和非阻塞性致病机制,包括微血管功能障碍,血管缩疾病和非冠状动脉病因.
- 保持既定的MI类别,同时适应非阻塞性冠状动脉的缺血和MI的新术语.
结论:
- 拟议的命名为了解心肌缺血提供了一个更全面的框架.
- 这种统一的术语旨在通过解决心痛,缺血和心脏病发作的多种病理生理原因来完善诊断和治疗策略.
- 采用这种包容性分类应该导致更有针对性的患者治疗和改善缺血性心脏病的结果.
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