循環器ジャーナル71巻1号

2023年01月発行

特集 ここが変わった！循環器診療 最新スタンダード Ⅰ．疾患各論

急性冠動脈症候群

著者： 青木二郎¹

所属機関： ¹三井記念病院循環器内科

ページ範囲：P.33 - P.37

ここが変わった！
●過去のスタンダード
　・急性冠動脈症候群の診断にCK-MBを心筋バイオマーカーとして使用していた．
　・急性冠動脈症候群のPCIでは鼠径アプローチを使用することが多かった．
　・急性冠動脈症候群のPCI後におけるDAPT療法は1年以上継続していた．
●現在のスタンダード
　・急性冠動脈症候群の診断や重症度判定には心筋トロポニンの測定が必須である．
　・急性冠動脈症候群のPCIでは橈骨動脈アプローチが第一選択である．
　・急性冠動脈症候群のPCI後におけるDAPT療法は，高出血リスクの場合は1〜3カ月間と短縮されてきている．

参考文献

1）Kimura K, Kimura T, Ishihara M, et al. JCS 2018 Guideline on Diagnosis and Treatment of Acute Coronary Syndrome. Circ J 2019 ; 83 : 1085-196.

2）Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation : The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology（ESC）. Eur Heart J 2018 ; 39 : 119-77.

3）Collet JP, Thiele H, Barbato E, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2021 ; 42 : 1289-367.

4）Patel MR, Calhoon JH, Dehmer GJ, et al. ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2016 Appropriate Use Criteria for Coronary Revascularization in Patients With Acute Coronary Syndromes : A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and the Society of Thoracic Surgeons. J Am Coll Cardiol 2017 ; 69 : 570-91.

5）Jneid H, Addison D, Bhatt DL, et al. 2017 AHA/ACC Clinical Performance and Quality Measures for Adults With ST-Elevation and Non-ST-Elevation Myocardial Infarction : A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. J Am Coll Cardiol 2017 ; 70 : 2048-90.

6）Hofmann R, James SK, Jernberg T, et al. Oxygen Therapy in Suspected Acute Myocardial Infarction. N Engl J Med 2017 ; 377 : 1240-9.

7）Jolly SS, Yusuf S, Cairns J, et al. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes（RIVAL） : a randomised, parallel group, multicentre trial. Lancet 2011 ; 377 : 1409-20.

8）Valgimigli M, Frigoli E, Leonardi S, et al. Radial versus femoral access and bivalirudin versus unfractionated heparin in invasively managed patients with acute coronary syndrome（MATRIX） : final 1-year results of a multicentre, randomised controlled trial. Lancet 2018 ; 392 : 835-48.

9）Frobert O, Lagerqvist B, Olivecrona GK, et al. Thrombus aspiration during ST-segment elevation myocardial infarction. N Engl J Med 2013 ; 369 : 1587-97.

10）Jolly SS, Cairns JA, Yusuf S, et al. Randomized trial of primary PCI with or without routine manual thrombectomy. N Engl J Med 2015 ; 372 : 1389-98.

11）Nakamura M, Kimura K, Kimura T, et al. JCS 2020 Guideline Focused Update on Antithrombotic Therapy in Patients With Coronary Artery Disease. Circ J 2020 ; 84 : 831-65.

12）Puymirat E, Cayla G, Simon T, et al. Multivessel PCI Guided by FFR or Angiography for Myocardial Infarction. N Engl J Med 2021 ; 385 : 297-308.