AHA声明：CABG术后二级预防之合并疾病的管理
2月9日，美国心脏学会(AHA)在《循环》(Circulation)杂志上发布了《AHA科学声明：冠状动脉旁路移植术后二级预防》。金宝搏网站登录技巧 小编为您编译了该声明的抗血小板治疗和抗栓治疗、受体阻滞剂治疗推荐要点。 更多内容请点此下载原文：AHA科学声明：冠状动脉旁路移植术后二级预防 有心梗史和左室功能不全 推荐建议 推荐级别
2月9日，美国心脏学会(AHA)在《循环》(Circulation)杂志上发布了《AHA科学声明：冠状动脉旁路移植术后二级预防》。金宝搏网站登录技巧 小编为您编译了该声明的抗血小板治疗和抗栓治疗、β受体阻滞剂治疗和预防和康复推荐要点。
更多内容请点此下载原文：AHA科学声明：冠状动脉旁路移植术后二级预防
有心梗史和左室功能不全 |
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推荐建议 |
推荐级别 |
1、 除非有禁忌，对所有射血分数（EF）降低（＜40%），尤其是有心衰或心肌梗死病史者，推荐使用β受体阻滞剂（比索洛尔、琥珀酸美托洛尔缓释片、卡维地洛）。
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I类推荐，A级证据 |
2、除非有禁忌，对有左室功能不全（EF<40%）的患者，推荐术后使用肾素血管紧张死转换酶抑制剂（ACEI）或血管紧张素受体拮抗剂（ARB，患者不耐受ACEI时）。
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I类推荐，B级证据 |
3、除非有禁忌，对出现左室功能不全（EF<35%）、纽约心脏学会(NYHA)心功能分级II~IV的患者，术后在β受体阻滞剂和ACEI基础上加用醛固酮受体拮抗剂是合理的。
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IIa类推荐，B级证据 |
4、对有左室功能不全（EF<35%）的患者，在术后未接受3个月有明确目标的药物治疗和确定有持续左室功能不全前，不推荐使用埋藏式心律转复除颤器（ICD）预防心脏性猝死。
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III类推荐，A级证据 |
188bet在线平台网址 |
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对多数患者，术后糖化血红蛋白（HbA1c）水平控制到7%以下是合理的，以减少微血管和大血管并发症。
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IIa类推荐，B级证据 |
肥胖与代谢综合征 |
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1、应评估患者向心性体脂分布程度（测量腰围、臀围并计算腰臀比），即使体质指数（BMI）正常。
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IIa类推荐，C级证据 |
2、对BMI 高于35 kg/m2的患者，如生活方式干预无法达到有效减重效果，应考虑减肥手术。
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IIb类推荐，C级证据 |
Previous MI and LV Dysfunction Recommendations
1. In the absence of contraindications, β-blockers (bisoprolol,carvedilol, and sustained-release metoprolol succinate) are recommended after CABG to all patients with reduced EF (<40%), especially among patients with heart failure or those with prior MI(Class I; Level of Evidence A).
2. In the absence of contraindications, ACE inhibitor or ARB therapy (if the patient is ACE inhibitor intolerant)is recommended after CABG to all patients with LV dysfunction (EF <40%) or previous MI (Class I;Level of Evidence B).
3. In the absence of contraindications, it is reasonable to add an aldosterone antagonist (on top of β-blocker and ACE inhibitor therapy) after CABG for patients with LV dysfunction (EF <35%) who have class NYHA class II to IV heart failure symptoms (ClassIIa; Level of Evidence B).
4. Among patients with LV dysfunction (EF <35%),ICD therapy is not recommended for the prevention of sudden cardiac death after CABG until 3 months of postoperative goal-directed medical therapy has been provided and persistent LV dysfunction has been confirmed (Class III; Level of Evidence A).
Diabetes Mellitus Recommendations
1. Striving to achieve an HbA1c of 7% is a reasonable goal for most patients after CABG to reduce microvascular diabetic complications and macrovascular cardiovascular disease (Class IIa; Level of Evidence B).
Obesity and Metabolic Syndrome Recommendations
1. The assessment of central distribution of fat is reasonable in CABG patients by measuring waist and hip circumference and calculating waist-to-hip ratio,even if the BMI is within normal limits (Class IIa;Level of Evidence C).
2. Bariatric surgery may be considered for CABG patients with a BMI >35 kg/m2 if lifestyle interventions have already been attempted without meaningful weight loss (Class IIb; Level of Evidence C).
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