Cilingiroglu Mehmet, Khan Faisal
University of Cincinnati Medical Center, 231 Albert Sabin Way, Cincinnati, OH 45267, USA.
Curr Atheroscler Rep. 2009 Mar;11(2):146-8. doi: 10.1007/s11883-009-0023-9.
Coronary artery disease with acute coronary syndromes (ACS) is the leading cause of death worldwide in both men and women. ACS mostly occur as a result of rupture of "vulnerable plaque" with a superimposed thrombus formation, which ultimately leads to distal cessation of blood flow. Vulnerable plaque mostly occurs in mildly obstructive coronary lesions rather than severely stenosed (< 50%) lesions. Support for this conclusion comes from studies of patients with ACS who had a recent prior coronary angiogram; the artery involved in the subsequent ACS was usually only moderately diseased. Whether early treatment of these mildly obstructive lesions with percutaneous coronary interventions may lead to prevention of this deadly malady remains unknown. The long-term efficacy of percutaneous coronary intervention for mildly obstructive coronary narrowing is limited by the occurrence of restenosis, which limits the applicability of this therapy for these lesions. However, use of drug-eluting stents has significantly reduced the incidence of in-stent restenosis, yielding much better long-term outcomes. This article reviews the available data for possible early treatment of mildly obstructive coronary lesions with drug-eluting stents for prevention of ACS.
伴有急性冠状动脉综合征（ACS）的冠状动脉疾病是全球男性和女性死亡的主要原因。急性冠状动脉综合征大多是由于“易损斑块”破裂并伴有血栓形成，最终导致远端血流中断。易损斑块大多发生在轻度阻塞性冠状动脉病变而非严重狭窄（<50%）的病变中。这一结论的依据来自对近期接受过冠状动脉造影的急性冠状动脉综合征患者的研究；随后发生急性冠状动脉综合征的动脉通常只是中度病变。经皮冠状动脉介入治疗这些轻度阻塞性病变是否能预防这种致命疾病尚不清楚。经皮冠状动脉介入治疗轻度阻塞性冠状动脉狭窄的长期疗效受到再狭窄发生的限制，这限制了该疗法对这些病变的适用性。然而，药物洗脱支架的使用显著降低了支架内再狭窄的发生率，产生了更好的长期效果。本文综述了有关使用药物洗脱支架早期治疗轻度阻塞性冠状动脉病变以预防急性冠状动脉综合征的现有数据。
