Sulimov Dmitriy S, Abdel-Wahab Mohamed, Richardt Gert
Heart Center, Segeberger Kliniken GmbH, Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg, Bad Segeberg, Germany.
Cardiol Ther. 2015 Jun;4(1):39-46. doi: 10.1007/s40119-015-0040-4. Epub 2015 Jun 9.
In patients presenting with ST-segment elevation myocardial infarction (STEMI) and multi-vessel disease (MVD), the optimal therapy for non-culprit lesions is still a matter of debate. While guidelines discourage a concomitant treatment of infarct- and non-infarct-related arteries, recent studies document advantages of a complete (preventive) revascularization during primary percutaneous coronary intervention. Such an approach, however, may result in overtreatment, because angiography does not provide robust information about the functional severity of MVD. Fractional flow reserve (FFR) measurements can be a valuable guide for non-culprit lesions in acute myocardial infarction, but so far, only the reliability and safety of FFR measurements have been established in this setting. The clinical implications of an FFR-guided treatment strategy in STEMI patients with MVD are currently being tested in a large randomized trial.
在表现为ST段抬高型心肌梗死（STEMI）且患有多支血管病变（MVD）的患者中，非罪犯病变的最佳治疗方法仍存在争议。虽然指南不鼓励同时治疗梗死相关动脉和非梗死相关动脉，但近期研究证明了在直接经皮冠状动脉介入治疗期间进行完全（预防性）血运重建的优势。然而，这种方法可能会导致过度治疗，因为血管造影无法提供关于MVD功能严重程度的可靠信息。血流储备分数（FFR）测量对于急性心肌梗死中的非罪犯病变可能是一个有价值的指导，但到目前为止，仅在这种情况下确定了FFR测量的可靠性和安全性。FFR指导的治疗策略对患有MVD的STEMI患者的临床意义目前正在一项大型随机试验中进行测试。
