Kirtane Ajay J, Doshi Darshan, Leon Martin B, Lasala John M, Ohman E Magnus, O'Neill William W, Shroff Adhir, Cohen Mauricio G, Palacios Igor F, Beohar Nirat, Uriel Nir, Kapur Navin K, Karmpaliotis Dimitri, Lombardi William, Dangas George D, Parikh Manish A, Stone Gregg W, Moses Jeffrey W
From Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Cardiovascular Research Foundation, New York, NY (A.J.K., D.D., M.B.L., D.K., M.A.P., G.W.S., J.W.M.); Washington University in St. Louis, St. Louis, MO (J.M.L.); The Program for Advanced Coronary Disease, Duke University Medical Center, Durham, NC (E.M.O.); Henry Ford Hospital, Detroit, MI (W.W.O.); University of Illinois, Chicago (A.S.); University of Miami Miller School of Medicine, Miami, FL (M.G.C.); Massachusetts General Hospital, Harvard Medical School, Boston (I.F.P.); Mount Sinai Medical Center, Miami, FL (N.B.); University of Chicago, Chicago, IL (N.U.); Tufts Medical Center, Boston, MA (N.K.K.); University of Washington Medical Center, Seattle (W.L.); and Mount Sinai Medical Center, New York, NY (G.D.D.).
Circulation. 2016 Aug 2;134(5):422-31. doi: 10.1161/CIRCULATIONAHA.116.022061.
Patients with severe coronary artery disease with a clinical indication for revascularization but who are at high procedural risk because of patient comorbidities, complexity of coronary anatomy, and/or poor hemodynamics represent an understudied and potentially underserved patient population. Through advances in percutaneous interventional techniques and technologies and improvements in patient selection, current percutaneous coronary intervention may allow appropriate patients to benefit safely from revascularization procedures that might not have been offered in the past. The burgeoning interest in these procedures in some respects reflects an evolutionary step within the field of percutaneous coronary intervention. However, because of the clinical complexity of many of these patients and procedures, it is critical to develop dedicated specialists within interventional cardiology who are trained with the cognitive and technical skills to select these patients appropriately and to perform these procedures safely. Preprocedural issues such as multidisciplinary risk and treatment assessments are highly relevant to the successful treatment of these patients, and knowledge gaps and future directions to improve outcomes in this emerging area are discussed. Ultimately, an evolution of contemporary interventional cardiology is necessary to treat the increasingly higher-risk patients with whom we are confronted.
患有严重冠状动脉疾病且有血运重建临床指征，但因患者合并症、冠状动脉解剖结构复杂和/或血流动力学不佳而处于高手术风险的患者，是一个研究不足且可能未得到充分治疗的患者群体。随着经皮介入技术和工艺的进步以及患者选择的改善，目前的经皮冠状动脉介入治疗可能使合适的患者安全地从过去可能未提供的血运重建手术中获益。在某些方面，对这些手术日益增长的兴趣反映了经皮冠状动脉介入治疗领域的一个发展阶段。然而，由于这些患者和手术中的许多临床复杂性，培养介入心脏病学领域的专业专家至关重要，这些专家要经过培训，具备认知和技术技能，以便正确选择这些患者并安全地进行这些手术。术前问题，如多学科风险和治疗评估，与这些患者的成功治疗高度相关，本文还讨论了这一新兴领域的知识差距和改善预后的未来方向。最终，当代介入心脏病学的发展对于治疗我们所面对的风险越来越高的患者是必要的。
