Medizinische Klinik und Poliklinik II, Herzzentrum Bonn, Universitätsklinikum Bonn, 53105, Bonn, Germany.
Clin Res Cardiol. 2018 Aug;107(Suppl 2):64-73. doi: 10.1007/s00392-018-1316-1. Epub 2018 Jul 5.
In recent years, the percentage of patients with multivessel disease and multiple complex stenoses have significantly increased. One factor contributing to this increase is the proportion of elderly and very elderly patients who have been turned down by the Heart Team for surgical revascularization (Landes et al. in Catheter Cardiovasc Interv, https://doi.org/10.1002/ccd.27375 , 2017; Waldo et al. in Circulation 130:2295-2301, https://doi.org/10.1161/CIRCULATIONAHA.114.011541 , 2014). In addition, the marked increase in patients with significant comorbidities further contributes to the increase in patients referred to the interventional cardiologist for stenting procedures. Mostly, the complexity of these patients is characterized not only by their comorbidities but also by multivessel disease, bifurcation disease, left main disease, or stenoses of calcified or tortuous vessels, degenerated saphenous vein graft lesions, and thrombotic lesions (Kirtane et al. in Circulation 134:422-431, 2016; Gennaro Giustino et al. in JACC 86:1851-1864, 2016) These specific lesion types are typically associated with lower rates of procedural success and higher rates of recurrence or major adverse cardiac events (Kirtane et al. 2016) Coming along with this problem, virtually no study exists evaluating revascularization strategies, i.e. percutaneous coronary intervention (PCI), coronary artery bypass graft surgery, or medical therapy alone in complex patients with complex coronary anatomy. Therefore, we are confronted with an increasing patient population that is understudied and potentially underserved. In the absence of robust, accurate, objective, and consistent evidence which could help us in decision-making (e.g. best revascularization strategy, complication prevention, post-interventional medical therapy), we have to stick to personal experience and patients' preferences. In this article, we provide an overview about common definition of complex PCI, general strategies to help decision-making in these patients, and give an overview about post-interventional medical treatment.
近年来，多支血管病变和多处复杂狭窄的患者比例显著增加。导致这种增加的一个因素是接受心脏团队手术血管重建评估被拒绝的老年和非常老年患者的比例（Landes 等人，发表于 Catheter Cardiovasc Interv，https://doi.org/10.1002/ccd.27375，2017 年；Waldo 等人，发表于 Circulation 130:2295-2301，https://doi.org/10.1161/CIRCULATIONAHA.114.011541，2014 年）。此外，患有显著合并症的患者数量的显著增加进一步导致更多患者被转诊至介入心脏病学家进行支架置入术。这些患者的复杂性不仅表现为合并症，还表现为多支血管病变、分叉病变、左主干病变或钙化或迂曲血管狭窄、退化的大隐静脉桥病变以及血栓病变（Kirtane 等人，发表于 Circulation 134:422-431，2016 年；Gennaro Giustino 等人，发表于 JACC 86:1851-1864，2016 年）。这些特定的病变类型通常与较低的手术成功率和较高的复发或主要不良心脏事件率相关（Kirtane 等人，2016 年）。随着这一问题的出现，实际上没有研究评估复杂患者的血运重建策略，即经皮冠状动脉介入治疗（PCI）、冠状动脉旁路移植术或单纯药物治疗。因此，我们面临着越来越多的研究不足和潜在服务不足的患者群体。在缺乏有助于我们决策的稳健、准确、客观和一致的证据的情况下（例如最佳血运重建策略、并发症预防、介入后药物治疗），我们只能依靠个人经验和患者的偏好。在本文中，我们提供了对常见复杂 PCI 定义的概述，以及帮助决策的一般策略，并对介入后药物治疗进行了概述。
