Buxton Brian F, Fuller John
Department of Cardiac Surgery, Austin Hospital, Melbourne, Vic., Australia.
Heart Lung Circ. 2004;13 Suppl 3:S7-S12. doi: 10.1016/j.hlc.2004.09.014.
The treatment of coronary artery disease, initially by medical and surgical and subsequently using percutaneous interventions, has evolved rapidly over the last 50 years. Randomized controlled clinical trials and observational studies of large cohorts have been instrumental in the evolution of the current practice of coronary artery revascularisation. This paper traces some of the historic trials of medical versus surgical therapy, surgical versus percutaneous intervention and graft patency studies. Medical therapy and percutaneous intervention are now the primary therapeutic modalities. However, there was an early recurrence rate with percutaneous intervention which has decreased with the use of drug-eluting stents. Coronary artery bypass surgery remains a major option for treating advanced coronary artery disease. Furthermore, it remains the treatment of first choice in most patients with left main coronary artery disease and those with extensive three-vessel proximal coronary artery disease, especially when associated with poor left ventricular function. The choice of a coronary artery bypass conduit is of major importance in developing a single long-term strategy for the surgical treatment of coronary artery disease. Bilateral internal thoracic artery grafting is now accepted as the treatment of choice, although not universally practiced. The role of other arterial conduits is being defined.
在过去50年中，冠状动脉疾病的治疗方法迅速演变，最初是药物和手术治疗，随后采用经皮介入治疗。大型队列的随机对照临床试验和观察性研究对当前冠状动脉血运重建实践的发展起到了重要作用。本文追溯了一些医学治疗与手术治疗、手术治疗与经皮介入治疗以及移植血管通畅性研究的历史性试验。药物治疗和经皮介入治疗现在是主要的治疗方式。然而，经皮介入治疗早期存在复发率，随着药物洗脱支架的使用，这一复发率有所降低。冠状动脉旁路移植术仍然是治疗晚期冠状动脉疾病的主要选择。此外，对于大多数左主干冠状动脉疾病患者以及广泛的三支近端冠状动脉疾病患者，尤其是伴有左心室功能不佳的患者，它仍然是首选治疗方法。在制定冠状动脉疾病手术治疗的单一长期策略时，冠状动脉旁路移植管道的选择至关重要。双侧胸廓内动脉移植目前被公认为首选治疗方法，尽管并非普遍采用。其他动脉管道的作用正在被明确。
