Patel Shalin, Bailey Steven R
From the Janey Briscoe Center of Excellence for Cardiovascular Research, University of Texas Health Science Center at San Antonio, San Antonio, TX, 78232, USA.
Curr Cardiol Rep. 2017 Aug 24;19(10):93. doi: 10.1007/s11886-017-0906-2.
This review will address the clinical conundrum of those who may derive clinical benefit from complete revascularization of coronary stenosis that are discovered at the time of ST segment elevation myocardial infarction (STEMI). The decision to revascularize additional vessels with angiographic stenosis beyond the culprit lesion remains controversial, as does the timing of revascularization.
STEMI patients represent a high-risk patient population that have up to a 50% prevalence of multivessel disease. Multivessel disease represents an important risk factor for short- and long-term morbidity and mortality. Potential benefits of multivessel PCI for STEMI might include reduced short- and long-term mortality, revascularization, reduced resource utilization, and costs. Which population will benefit and what the optimal timing of revascularization in the peri-MI period remains controversial. Consideration of multivessel revascularization in the setting of STEMI may occur in up to one half of STEMI patients. Evaluation of the comorbidities including diabetes, extent of myocardium at risk, lesion complexity, ventricular function, and risk factors for complications such as contrast induced nephropathy which is important in determining the appropriate care pathway.
本综述将探讨那些在ST段抬高型心肌梗死（STEMI）发作时发现冠状动脉狭窄，可能从完全血运重建中获得临床益处的患者所面临的临床难题。对于除罪犯病变外存在血管造影狭窄的其他血管进行血运重建的决策，以及血运重建的时机，仍存在争议。
STEMI患者是高危患者群体，多支血管病变的患病率高达50%。多支血管病变是短期和长期发病及死亡的重要危险因素。STEMI患者进行多支血管PCI的潜在益处可能包括降低短期和长期死亡率、血运重建、减少资源利用和成本。哪些人群将从中受益以及在心肌梗死围手术期血运重建的最佳时机仍存在争议。在STEMI患者中，多达一半的患者可能会考虑进行多支血管血运重建。评估合并症，包括糖尿病、危险心肌范围、病变复杂性、心室功能以及造影剂肾病等并发症的危险因素，对于确定合适的治疗途径很重要。
