a Hospital Clínic, Cardiovascular Clinic Institute , Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) , Barcelona , Spain.
Expert Rev Med Devices. 2018 Nov;15(11):807-817. doi: 10.1080/17434440.2018.1538778. Epub 2018 Oct 30.
Ischemic heart disease is the most common cause of mortality worldwide. In ST elevation myocardial infarction (STEMI) patients, optimization of primary percutaneous coronary intervention (pPCI) is crucial to improve myocardial savage and prevent reperfusion injury. In STEMI patients complicated with cardiogenic shock (CS), percutaneous mechanical circulatory support devices (MCS) have emerged as a therapeutic option in the management of this challenging condition and their use is rapidly increasing.
In this review we discuss how pPCI can be optimized with respect to thrombectomy use, stent selection and revascularization strategy, in order to reduce myocardial damage and to improve clinical outcomes. Moreover, we review the recently-published data for and against the use of commercially available MCS in STEMI patients complicated by CS (intra-aortic balloon pump counterpulsation (IABP), Impella system, TandemHeart, and venous-arterial extracorporeal membrane oxygenation (VA-ECMO)).
In pPCI, second-generation drug-eluting stent implantation and complete revascularization are always recommended. Thrombectomy does not have any role in improving mortality. In patients with CS, current MCS have shown no improvement in mortality.
缺血性心脏病是全球最常见的死亡原因。在 ST 段抬高型心肌梗死（STEMI）患者中，优化直接经皮冠状动脉介入治疗（pPCI）对于改善心肌存活和预防再灌注损伤至关重要。在合并心源性休克（CS）的 STEMI 患者中，经皮机械循环支持装置（MCS）已成为治疗这种挑战性疾病的一种选择，其应用正在迅速增加。
在这篇综述中，我们讨论了如何通过使用血栓切除术、支架选择和血运重建策略来优化 pPCI，以减少心肌损伤并改善临床结局。此外，我们还回顾了最近发表的数据，探讨了在合并 CS 的 STEMI 患者中使用商业 MCS 的利弊（主动脉内球囊反搏（IABP）、Impella 系统、TandemHeart 和静脉-动脉体外膜肺氧合（VA-ECMO））。
在 pPCI 中，始终推荐使用第二代药物洗脱支架植入和完全血运重建。血栓切除术在改善死亡率方面没有任何作用。在心源性休克患者中，目前的 MCS 并未显示出死亡率的改善。
