心肌梗死后立即进行多血管血运重建：改变策略？

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-04-01 DOI:10.1093/eurheartjsupp/suae015

P. Capranzano, Luca Lombardo

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引用次数: 0

摘要

多支血管冠状动脉疾病（MVD）是ST段抬高型心肌梗死（STEMI）患者接受原发性经皮冠状动脉介入治疗（PCI）时经常遇到的情况。多项研究表明，与只治疗 STEMI 患者的罪魁祸首病变相比，进行完全冠状动脉血运重建更有益处。基于这些证据，目前的欧洲指南建议，对于血流动力学稳定的 STEMI 和 MVD 患者，应在治疗冠状动脉病变的同时在同一手术中实现常规的完全血运重建（即刻多血管 PCI），或在对冠状动脉病变进行指数 PCI 后 45 天内进行后续介入治疗（延迟多血管 PCI）。然而，指南并未对立即多血管 PCI 与延迟多血管 PCI 作出倾向性规定。因此，对于 STEMI 患者非罪魁祸首病变的最佳治疗时机和血流动力学稳定性仍存在争议，最近的研究对这一问题进行了评估，结果显示即刻与延迟多血管 PCI 并无优越性。文章讨论了这些研究对 STEMI 血流动力学稳定患者非病灶完全再血管化时机的结果和临床意义。

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Immediate multivessel revascularization after myocardial infarction: change of strategy?

Multivessel coronary artery disease (MVD) is a frequently encountered condition in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) of the culprit vessel. Several studies have demonstrated the benefit of complete coronary revascularization compared with the treatment of the culprit lesion only in patients with STEMI. Based on this evidence, the current European guidelines recommend that in haemodynamically stable patients with STEMI and MVD, routine complete revascularization should be achieved either during the same procedure in concomitance with the treatment of the culprit lesion (immediate multivessel PCI) or with a subsequent intervention within 45 days from the index PCI of the culprit lesion (deferred multivessel PCI). However, the guidelines do not express a preference for immediate vs. delayed multivessel PCI. Therefore, the optimal timing of the treatment of non-culprit lesions in patients with STEMI and haemodynamic stability is still debated and has been evaluated in recent studies that showed the non-inferiority of immediate vs. delayed multivessel PCI. The article discusses the results and clinical implications of these studies on the timing of complete revascularization of non-culprit lesions in haemodynamically stable patients with STEMI.

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.