EMO-GVM Centro Cuore Columbus, Via Buonarotti 48, 20145 Milan, Italy.
Nat Rev Cardiol. 2012 Jan 31;9(4):243-52. doi: 10.1038/nrcardio.2011.213.
The primary objective of invasive treatment strategies for multivessel coronary artery disease is complete anatomical revascularization--traditionally considered the strongest predictor of improved clinical outcome in this setting. This concept, however, is being challenged by evidence suggesting that addressing ischemia is the key to reducing mortality, myocardial infarction, and life-limiting angina. As objective evidence of ischemia can be provided by a functional assessment on the basis of fractional flow reserve, the focus of contemporary treatment should arguably shift from anatomical to functional revascularization. Moreover, the decision to revascularize specific lesions should be made after consideration of the degree of myocardial viability, ischemic burden, overall clinical risk, and technical feasibility. Most importantly, however, the revascularization strategy should be tailored to the individual patient and the expertise of the institution, and use contemporary techniques combined with modern pharmacotherapy. This Perspectives article summarizes the data supporting contemporary functional revascularization and its applicability to real-world practice.
多支血管冠状动脉疾病的介入治疗策略的主要目标是完全解剖性血运重建——传统上认为这是改善该治疗环境下临床预后的最强预测因素。然而，有证据表明，解决缺血是降低死亡率、心肌梗死和限制生命的心绞痛的关键，这一概念受到了挑战。由于缺血的客观证据可以通过基于血流储备分数的功能评估提供，因此当代治疗的重点无疑应该从解剖性血运重建转移到功能性血运重建。此外，在考虑心肌活力、缺血负担、整体临床风险和技术可行性后，才应决定对特定病变进行血运重建。然而，最重要的是，血运重建策略应根据患者个体情况和医疗机构的专业知识进行调整，并结合现代药理学使用当代技术。本文观点总结了支持当代功能性血运重建及其在实际应用中的数据。
