Current Opinion in Cardiology最新文献

Beyond stenosis: imaging phenotyping and risk stratification in nonobstructive coronary artery disease. 超越狭窄：非阻塞性冠状动脉疾病的影像学表型和风险分层。

IF 1.9 4区医学

Current Opinion in Cardiology Pub Date : 2026-11-01 Epub Date: 2026-09-01 DOI: 10.1097/HCO.0000000000001341

Pamela Piña, Annalisa Filtz, Daniel Lorenzatti, Ankur Srivastava, Jaideep Singh Bhalla, Piotr J Slomka, Daniel S Berman, Damini Dey, Leandro Slipczuk

{"title":"Beyond stenosis: imaging phenotyping and risk stratification in nonobstructive coronary artery disease.","authors":"Pamela Piña, Annalisa Filtz, Daniel Lorenzatti, Ankur Srivastava, Jaideep Singh Bhalla, Piotr J Slomka, Daniel S Berman, Damini Dey, Leandro Slipczuk","doi":"10.1097/HCO.0000000000001341","DOIUrl":"10.1097/HCO.0000000000001341","url":null,"abstract":"Purpose of review: Nonobstructive coronary artery disease (NOCA) is now frequently detected by coronary CT angiography (CCTA), but the term compresses biologically distinct patterns into a single anatomic label. This review examines how CT-derived markers can reorganize NOCA around plaque burden, inflammatory activity, clinical expression, and temporal change.Recent findings: Recent work distinguishes three related but distinct tasks in NOCA: identify disease, stratify risk, and define phenotypes that may inform future prevention strategies. CCTA addresses the atherosclerotic and prognostic dimensions by quantifying plaque burden, plaque composition, and high-risk features; CT-derived inflammatory and cardiometabolic markers may further identify active vascular and metabolic phenotypes. In symptomatic patients, CCTA and fractional flow reserve CT can evaluate epicardial anatomy and lesion-specific hemodynamic significance, but normal or nonobstructive findings do not exclude coronary microvascular dysfunction or vasospasm. In asymptomatic patients, coronary artery calcium and CCTA can reveal subclinical atherosclerosis and refine preventive risk assessment. Serial imaging and intervention studies suggest that adverse plaque phenotypes can stabilize or change with intensive prevention, but outcome-proven CCTA-guided treatment algorithms are still lacking.Summary: CCTA is evolving into a multidimensional phenotyping tool for NOCA. Its immediate value is refined risk stratification; whether these markers will improve outcomes remains unproven and should be tested prospectively.","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"564-574"},"PeriodicalIF":1.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Strategies for increasing adoption of multiarterial coronary bypass grafting. 增加多动脉冠状动脉旁路移植术应用的策略。

IF 1.9 4区医学

Current Opinion in Cardiology Pub Date : 2026-11-01 Epub Date: 2026-08-26 DOI: 10.1097/HCO.0000000000001342

Joshua L Leibowitz, Bartley P Griffith, James M Brown

{"title":"Strategies for increasing adoption of multiarterial coronary bypass grafting.","authors":"Joshua L Leibowitz, Bartley P Griffith, James M Brown","doi":"10.1097/HCO.0000000000001342","DOIUrl":"10.1097/HCO.0000000000001342","url":null,"abstract":"Purpose of review: Recent studies have demonstrated a survival benefit in patients receiving multiarterial rather than single-arterial coronary artery bypass grafting; however, it remains underutilized and is only implemented in a minority of patients in North America. We aim to review contemporary data on the survival benefit for multiarterial bypass grafting as well as the support for various grafting strategies and conduit options to increase multiarterial grafting utilization.Recent findings: While randomized data is lacking, national database and cohort studies have observed improved survival in nearly all patient populations receiving multiarterial grafting compared to single-arterial grafting. Despite this multiarterial grafting is used in only 15% of isolated coronary bypass graftings in the United States. Several studies have demonstrated the effectiveness of different conduit options and operative strategies to increase arterial conduit utilization. These include the addition of a radial artery graft, bilateral internal thoracic artery grafting, and sequential and composite conduit grafting.Summary: There is a well described late survival benefit for multiarterial bypass grafting over single arterial grafting. Recent studies support a variety of conduit choices and operative strategies to increase multiarterial bypass grafting in a safe, stepwise fashion.","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"507-512"},"PeriodicalIF":1.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148834984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Antithrombotic therapy to minimize total events after ACS or PCI in atrial fibrillation: insights from AUGUSTUS. 抗栓治疗减少房颤ACS或PCI后总事件：来自AUGUSTUS的见解。

IF 1.9 4区医学

Current Opinion in Cardiology Pub Date : 2026-11-01 Epub Date: 2026-08-26 DOI: 10.1097/HCO.0000000000001336

Seung Hun Lee, Jennifer A Rymer, W Schuyler Jones

{"title":"Antithrombotic therapy to minimize total events after ACS or PCI in atrial fibrillation: insights from AUGUSTUS.","authors":"Seung Hun Lee, Jennifer A Rymer, W Schuyler Jones","doi":"10.1097/HCO.0000000000001336","DOIUrl":"10.1097/HCO.0000000000001336","url":null,"abstract":"Purpose of review: Antithrombotic therapy for patients with atrial fibrillation (AF) after acute coronary syndrome (ACS) or percutaneous coronary intervention (PCI) requires balancing prevention of stroke and coronary events against bleeding. Recent recurrent-event and patient-centered analyses of AUGUSTUS make this review timely by reframing treatment benefit beyond first events.Recent findings: Four dedicated trials support dual antithrombotic therapy with direct oral anticoagulants (DOAC) plus P2Y 12 inhibitor and early aspirin withdrawal to reduce bleeding without significant increase in ischemic events. However, aspirin-free strategies differ by anticoagulation indication: in patients without anticoagulation, very early aspirin withdrawal after ACS or PCI may increase the risk of coronary events, whereas in patients with AF receiving anticoagulation, oral anticoagulation may assume the early antithrombotic role of aspirin. AUGUSTUS showed that apixaban and placebo each reduced bleeding compared with vitamin K antagonist and aspirin. The recent total-event analyses further showed lower cumulative bleeding with apixaban than with vitamin K antagonist, and substantially greater cumulative bleeding with randomized aspirin than with placebo, along with similar total ischemic events and hospitalizations.Summary: For patients with AF after ACS or PCI, DOAC-based dual antithrombotic therapy provides the most favorable cumulative safety-efficacy balance. Future research should focus on the timing of aspirin discontinuation and validate recurrent-event endpoints.","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"593-599"},"PeriodicalIF":1.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Plaque vulnerability and cardiovascular risk factor burden in acute coronary syndromes: insights from optical coherence tomography. 急性冠脉综合征中的斑块易损性和心血管危险因素负担：来自光学相干断层扫描的见解。

IF 1.9 4区医学

Current Opinion in Cardiology Pub Date : 2026-11-01 Epub Date: 2026-08-26 DOI: 10.1097/HCO.0000000000001335

Jakub Chmiel, Piotr Musialek, Ik-Kyung Jang

{"title":"Plaque vulnerability and cardiovascular risk factor burden in acute coronary syndromes: insights from optical coherence tomography.","authors":"Jakub Chmiel, Piotr Musialek, Ik-Kyung Jang","doi":"10.1097/HCO.0000000000001335","DOIUrl":"10.1097/HCO.0000000000001335","url":null,"abstract":"Purpose of review: Both cardiovascular risk factors and features of coronary plaque vulnerability are associated with adverse cardiovascular outcomes, including acute coronary syndromes (ACS); however, these epidemiological and pathological concepts have evolved along largely separate tracks. This review discusses emerging evidence that modifiable cardiovascular risk factor burden is associated with plaque vulnerability, as assessed by optical coherence tomography (OCT).Recent findings: Recent large-scale OCT analyses suggest that, in patients with ACS, increasing modifiable cardiovascular risk factor burden is associated with a stepwise increase in culprit plaque features of vulnerability, including lipid-rich plaque, thin-cap fibroatheroma, macrophage accumulation, microvessels, and cholesterol crystals. This association was weaker in nonculprit plaques. In contrast, nonmodifiable risk factor burden was not associated with plaque vulnerability. These findings extend previous studies of individual risk factors by showing that cumulative modifiable risk burden is reflected in plaque phenotype.Summary: Current evidence supports the concept that cumulative modifiable cardiovascular risk factor burden may reflect coronary plaque biology, linking epidemiological risk assessment with imaging-defined plaque vulnerability. In this framework, cardiovascular risk factor burden may be understood as a surrogate of plaque vulnerability, linked to inflammatory, oxidative, and metabolic pathways. This association may help identify higher risk patients.","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"549-555"},"PeriodicalIF":1.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148834938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Colchicine for cardiovascular secondary prevention: evidence from recent trials and meta-analyses. 秋水仙碱用于心血管二级预防：来自近期试验和荟萃分析的证据。

IF 1.9 4区医学

Current Opinion in Cardiology Pub Date : 2026-11-01 Epub Date: 2026-09-01 DOI: 10.1097/HCO.0000000000001343

Valtteri Muroke, Michelle Samuel, Rolence Pierre, Jean-Claude Tardif

{"title":"Colchicine for cardiovascular secondary prevention: evidence from recent trials and meta-analyses.","authors":"Valtteri Muroke, Michelle Samuel, Rolence Pierre, Jean-Claude Tardif","doi":"10.1097/HCO.0000000000001343","DOIUrl":"10.1097/HCO.0000000000001343","url":null,"abstract":"Purpose of review: Residual inflammatory risk remains an important driver of recurrent vascular events despite contemporary lipid-lowering and antithrombotic therapies. Low-dose colchicine is the first widely available anti-inflammatory therapy to be incorporated into contemporary guidelines for secondary prevention in coronary artery disease. This review summarizes contemporary evidence on the efficacy and safety of low-dose colchicine for secondary prevention.Recent findings: Large randomized trials have demonstrated that colchicine reduces recurrent ischemic events in patients with chronic coronary disease and after myocardial infarction. Recent trials in acute myocardial infarction and stroke populations, however, have produced heterogeneous results. Nevertheless, contemporary meta-analyses consistently demonstrate reductions in major adverse cardiovascular events (MACE), driven mainly by fewer myocardial infarctions, strokes, and coronary revascularizations. Safety data are reassuring, with no consistent excess in serious infection, cancer, pneumonia, or noncardiovascular death, although gastrointestinal intolerance remains the most common adverse effect.Summary: Low-dose colchicine has established residual inflammation as an actionable target in secondary prevention of vascular events in patients with chronic coronary disease or recent myocardial infarction. Ongoing trials will clarify colchicine's role across broader vascular indications. Future work should also focus on implementing the use of colchicine for prevention of clinical events in patients with coronary artery disease in clinical practice.","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"584-592"},"PeriodicalIF":1.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

What represents complete surgical myocardial revascularization in 2026? 到2026年，什么是完全手术心肌血运重建术？

IF 1.9 4区医学

Current Opinion in Cardiology Pub Date : 2026-11-01 Epub Date: 2026-08-26 DOI: 10.1097/HCO.0000000000001338

Min-Seok Kim, Seong Wook Hwang, Ki-Bong Kim

{"title":"What represents complete surgical myocardial revascularization in 2026?","authors":"Min-Seok Kim, Seong Wook Hwang, Ki-Bong Kim","doi":"10.1097/HCO.0000000000001338","DOIUrl":"10.1097/HCO.0000000000001338","url":null,"abstract":"Purpose of review: Contemporary coronary artery bypass grafting (CABG) has traditionally defined complete revascularization anatomically; however, accumulating evidence suggests that angiographic stenosis severity alone does not reliably reflect myocardial ischemia or predict durable graft function. This review discusses the emerging transition from anatomy-based to physiology-guided complete revascularization and its relevance to contemporary CABG practice.Recent findings: Recent studies demonstrate that the prognostic impact of complete revascularization varies according to conduit strategy, target-vessel physiology, and graft durability. Competitive graft flow remains an important limitation of anatomy-based CABG, particularly in arterial composite grafting. Emerging evidence suggests that physiology-guided strategies using fractional flow reserve, computed tomography-derived fractional flow reserve (CT-FFR), and intraoperative transit-time flow measurement (TTFM) may improve target selection, reduce unnecessary grafting, minimize competitive flow, and optimize graft patency. Integration of preoperative CT-FFR with intraoperative TTFM has emerged as a complementary approach for physiology-guided surgical revascularization.Summary: The concept of complete revascularization is evolving from anatomical completeness toward durable physiologic myocardial revascularization. Integration of CT-FFR and TTFM may improve surgical planning, graft assessment, and conduit durability, potentially enhancing long-term outcomes. Further randomized studies are needed to establish standardized physiology-guided CABG strategies and define their impact on long-term graft patency and survival.","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"520-525"},"PeriodicalIF":1.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Coronary artery bypass grafting in women: optimizing operative outcomes. 女性冠状动脉旁路移植术：优化手术效果。

IF 1.9 4区医学

Current Opinion in Cardiology Pub Date : 2026-11-01 Epub Date: 2026-08-05 DOI: 10.1097/HCO.0000000000001332

Sofia Constantakis, Khyanna Lamarche-Silmser, Ellen Reed, Nadia A Clarizia, Marc Ruel, Fabiola B Sozzi

{"title":"Coronary artery bypass grafting in women: optimizing operative outcomes.","authors":"Sofia Constantakis, Khyanna Lamarche-Silmser, Ellen Reed, Nadia A Clarizia, Marc Ruel, Fabiola B Sozzi","doi":"10.1097/HCO.0000000000001332","DOIUrl":"10.1097/HCO.0000000000001332","url":null,"abstract":"Purpose of review: Women undergoing coronary artery bypass grafting (CABG) continue to experience worse perioperative and long-term outcomes than men despite advances in surgical techniques and perioperative care. This review summarizes contemporary evidence on sex-related differences in coronary artery disease (CAD), surgical outcomes, and secondary prevention. Gaps in the current evidence are identified and priorities for optimizing outcomes and informing sex-specific clinical practice are highlighted.Recent findings: Women present with distinct patterns of CAD, including higher prevalence of microvascular dysfunction and nonobstructive disease, contributing to delayed diagnosis and referral for surgical revascularization. Women are less likely to receive guideline-recommended revascularization strategies, including multiple arterial grafting. Women also experience higher rates of graft failure, mortality, and stroke after CABG. Emerging observational evidence suggests that off-pump and minimally invasive CABG approaches may reduce the disparities in female patients, although randomized sex-specific data remains limited. Secondary prevention remains suboptimal, with persistent gaps in implementation of guideline-directed therapies.Summary: Significant disparities persist across the continuum of care for women undergoing CABG, from diagnosis through long-term secondary prevention. Improving equitable implementation of evidence-based surgical strategies, increasing representation of women in randomized clinical trials, and developing sex-specific evidence are essential to optimize outcomes and inform future clinical guidelines.","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"538-548"},"PeriodicalIF":1.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Atrial fibrillation in coronary artery bypass patients: what should be offered. 冠状动脉搭桥术患者房颤：应该提供什么？

IF 1.9 4区医学

Current Opinion in Cardiology Pub Date : 2026-11-01 Epub Date: 2026-09-01 DOI: 10.1097/HCO.0000000000001334

Adam Eqbal, Emilie Belley-Cote, Richard Whitlock

{"title":"Atrial fibrillation in coronary artery bypass patients: what should be offered.","authors":"Adam Eqbal, Emilie Belley-Cote, Richard Whitlock","doi":"10.1097/HCO.0000000000001334","DOIUrl":"10.1097/HCO.0000000000001334","url":null,"abstract":"Purpose of review: Of patients undergoing coronary artery bypass grafting (CABG), 10-20% have preexisting atrial fibrillation (AF), which remains undertreated at the time of surgery. With rapidly evolving data, interest and enthusiasm for concomitant surgical management of AF have grown concurrently. This review summarizes the contemporary evidence, techniques, and approaches for surgical management of AF in patients undergoing CABG and proposes tailored operative strategies for these patients at the time of surgery.Recent findings: Concomitant surgical management of AF at the time of CABG is underutilized, with only 30-40% of eligible patients receiving concomitant AF treatment. Surgeons can offer a spectrum of options to concurrently treat AF, from left atrial appendage occlusion (LAAO) to a full biatrial Cox-maze iteration without significant additional perioperative risk. Contemporary large-scale observational analyses suggest concomitant surgical ablation improves rhythm outcomes and is associated with improved survival, and lower risk of stroke long-term.Summary: Concomitant LAAO is essential. Ablation techniques can be tailored based on the patient's burden of AF, clinical complexity, and surgeon expertise. A robust randomized trial is needed to convince clinicians to expand adoption.","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"513-519"},"PeriodicalIF":1.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Statins in abdominal aortic aneurysm: a risk-benefit analysis. 他汀类药物治疗腹主动脉瘤：风险-收益分析。

IF 1.9 4区医学

Current Opinion in Cardiology Pub Date : 2026-11-01 Epub Date: 2026-08-26 DOI: 10.1097/HCO.0000000000001337

Joachim Sejr Skovbo, Jes Sanddal Lindholt

{"title":"Statins in abdominal aortic aneurysm: a risk-benefit analysis.","authors":"Joachim Sejr Skovbo, Jes Sanddal Lindholt","doi":"10.1097/HCO.0000000000001337","DOIUrl":"10.1097/HCO.0000000000001337","url":null,"abstract":"Purpose of review: To evaluate emerging evidence supporting statins as a potential disease-modifying treatment for abdominal aortic aneurysm (AAA), a condition without approved pharmacological therapy.Recent findings: Recent nationwide registry analyses and prospective screening cohorts demonstrate consistent dose-dependent associations between statin exposure and reduced AAA growth, rupture, and surgical repair. In Danish screening trial cohorts, maximal statin exposure was associated with an approximately 0.88 mm/year reduction in aneurysm expansion, nearly halving observed growth rates. Mendelian randomization studies support a causal role of lipid pathways in AAA development and implicate HMG-CoA reductase activity in aneurysm development risk. The contribution of statins' pleiotropic effects may increase as AAA progresses, although direct clinical evidence remains limited. Contemporary randomized trial meta-analyses confirm a favourable safety profile, with only small excess risks of muscle symptoms and dysglycaemia.Summary: Convergent evidence from meta-analyses, drug-wide association study, prospective dose-response cohorts, and Mendelian randomization identifies high-intensity statin therapy as a leading pharmacological candidate for slowing AAA progression. Important uncertainties remain, including the absence of randomized trials and limited evidence in women. Nevertheless, given the favourable safety profile and the near-universal cardiovascular indication in this population, current evidence supports consideration of high-intensity statin therapy in patients with AAA.","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"556-563"},"PeriodicalIF":1.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148834889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Key advances in secondary prevention after coronary artery bypass grafting. 冠状动脉旁路移植术后二级预防的关键进展。

IF 1.9 4区医学

Current Opinion in Cardiology Pub Date : 2026-11-01 Epub Date: 2026-08-13 DOI: 10.1097/HCO.0000000000001333

Adham Elsherbini, Shubh K Patel, Liam Fedak, Subodh Verma

{"title":"Key advances in secondary prevention after coronary artery bypass grafting.","authors":"Adham Elsherbini, Shubh K Patel, Liam Fedak, Subodh Verma","doi":"10.1097/HCO.0000000000001333","DOIUrl":"10.1097/HCO.0000000000001333","url":null,"abstract":"Purpose of review: Coronary artery bypass grafting (CABG) improves prognosis in advanced coronary artery disease but does not halt native-vessel atherosclerosis or prevent graft failure. This review summarizes key advances in secondary prevention after CABG, emphasizing contemporary evidence, treatment shortcomings, and practical implications for long-term care.Recent findings: Intensive lipid lowering remains key, with high-intensity statins, ezetimibe, and PCSK9 inhibitors used sequentially to achieve very low LDL-C targets, while triglyceride-lowering therapy may benefit selected high-risk patients. Aspirin remains the cornerstone of antithrombotic therapy, whereas dual antiplatelet therapy should be patient-specific. Routine long-term beta-blocker or renin-angiotensin system inhibitor therapy should be guided by established indications rather than CABG alone, while calcium channel blockers may have a role after radial artery grafting. SGLT2 inhibitors, GLP-1 receptor agonists, cardiac rehabilitation, smoking cessation, obesity management, vaccination, and mental health and cognitive screening have broadened secondary prevention beyond traditional risk-factor control.Summary: Secondary prevention after CABG is a lifelong, multidisciplinary strategy aimed at preserving graft function, slowing disease progression, improving quality of life, and reducing recurrent cardiovascular events. Contemporary care should be individualized according to clinical phenotype, conduit strategy, comorbidity burden, thrombotic and bleeding risk, functional status, and treatment burden. Future studies should clarify persistent evidence gaps in antithrombotic therapy, cardiometabolic treatment, graft-specific outcomes, rehabilitation delivery, adherence, and patient-centered care.","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"526-537"},"PeriodicalIF":1.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148727122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0