Holmes David R, Gersh Bernard J, Whitlow Patrick, King Spencer B, Dove James T
Department of Cardiology, Division of Cardiovascular Disease and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
JACC Cardiovasc Interv. 2008 Feb;1(1):34-43. doi: 10.1016/j.jcin.2007.10.001.
As it approaches its fourth decade, percutaneous coronary intervention (PCI) is now the most widely used revascularization strategy around the world and has been tested in multiple clinical scenarios against both medical and surgical therapies. For each patient group and clinical scenario setting, the goals of therapy must be specifically defined and clearly understood as an integral component of the process of selecting the optimal strategy for the individual patient. In patients with chronic stable, often mild angina, the major achievable goals of PCI are to affect symptoms, either by decreasing them or preventing them, reduce the need for subsequent procedures, and relieve ischemia. Achievement of these goals has been documented in multiple randomized trials of PCI versus medical therapy. In these trials of patients with stable coronary artery disease (CAD), however, no reduction in death and myocardial infarction has been observed, and these limitations of PCI in this clinical setting need to be emphasized. Given the typically diffuse nature of CAD and the fact that PCI only treats a segment within a coronary artery, this is not surprising. Although optimal medical therapy forms the cornerstone of management for any patient with CAD, among stable patients who do fail medical therapy, percutaneous coronary revascularization plays a well-documented significant role in improving symptoms and preventing the subsequent need for revascularization. The appropriate utilization rates of PCI in patients with chronic stable angina and preserved left ventricular function should lead to more cost-effective care of patients with stable CAD.
在步入第四个十年之际，经皮冠状动脉介入治疗（PCI）现已成为全球应用最为广泛的血运重建策略，并已在多种临床情况下与药物及外科治疗进行了对比试验。对于每一组患者和临床情况设定，治疗目标都必须明确界定并作为为个体患者选择最佳策略过程的一个组成部分而被清楚理解。在患有慢性稳定性、通常为轻度心绞痛的患者中，PCI可实现的主要目标是通过减轻症状或预防症状来改善症状、减少后续手术的需求并缓解缺血。这些目标的实现已在多项PCI与药物治疗对比的随机试验中得到证实。然而，在这些针对稳定型冠状动脉疾病（CAD）患者的试验中，并未观察到死亡率和心肌梗死发生率的降低，并且需要强调PCI在这种临床情况下的这些局限性。鉴于CAD通常具有弥漫性，且PCI仅治疗冠状动脉内的一段，这并不奇怪。尽管最佳药物治疗是任何CAD患者管理的基石，但在药物治疗失败的稳定患者中，经皮冠状动脉血运重建在改善症状和预防后续血运重建需求方面发挥着已被充分证明的重要作用。慢性稳定性心绞痛且左心室功能保留的患者中PCI的合理使用率应能为稳定型CAD患者带来更具成本效益的治疗。
