Lu Daniel Y, Zhong Ming, Feldman Dmitriy N
Greenberg Division of Cardiology, Department of Medicine, From Weill Cornell Medical College, New York Presbyterian Hospital, 520 East 70th street, New York, NY, 10021, USA.
Curr Treat Options Cardiovasc Med. 2018 Apr 7;20(5):41. doi: 10.1007/s11936-018-0636-9.
In ST-segment elevation myocardial infarction, urgent revascularization of the culprit coronary vessel and restoration of coronary flow is the goal of the initial management. However, obstructive non-culprit disease is frequently concomitantly found during initial angiography and portends a poor prognosis. Management of non-culprit lesions in ST-segment elevation myocardial infarction (STEMI) has been the subject of extensive debate. This review will examine the currently available evidence, with a specific focus on randomized clinical trials performed to date.
Although early observational data suggested better outcomes with culprit-only revascularization, more recent data from several randomized trials have suggested improved outcomes with complete multivessel revascularization, either during the index PCI procedure or as a staged procedure. Data from recent randomized controlled trials have suggested the superiority of complete or multivessel revascularization and have subsequently led to changes to the most recent iterations of STEMI guidelines. However, the optimal management and timing of revascularization of non-culprit lesions in STEMI remain controversial.
在ST段抬高型心肌梗死中，对罪犯冠状动脉进行紧急血运重建并恢复冠状动脉血流是初始治疗的目标。然而，在初始血管造影时经常会同时发现阻塞性非罪犯病变，这预示着预后不良。ST段抬高型心肌梗死（STEMI）中非罪犯病变的处理一直是广泛争论的话题。本综述将审视目前可得的证据，特别关注迄今为止进行的随机临床试验。
尽管早期观察性数据表明仅对罪犯血管进行血运重建可获得更好的结果，但来自多项随机试验的最新数据表明，在首次经皮冠状动脉介入治疗（PCI）过程中或作为分期手术进行完全多支血管血运重建可改善预后。近期随机对照试验的数据表明完全或多支血管血运重建具有优越性，随后导致了STEMI指南最新版本的修订。然而，STEMI中非罪犯病变血运重建的最佳处理方法和时机仍存在争议。
