Neumann F-J, Hochholzer W, Siepe M
Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg ∙ Bad Krozingen, Südring 15, 79189, Bad Krozingen, Deutschland.
Klinik für Herz- und Gefäßchirurgie, Universitäts-Herzzentrum Freiburg ∙ Bad Krozingen, Bad Krozingen, Deutschland.
Herz. 2018 Dec;43(8):689-694. doi: 10.1007/s00059-018-4764-5.
The guidelines on myocardial revascularization published in 2018 are a joint initiative of the European Society of Cardiology and the European Association for Cardio-Thoracic Surgery. To establish indications for myocardial revascularization by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), evidence of the functional relevance of coronary artery stenoses is needed either by non-invasive imaging function tests or intravascular hemodynamic measurements. The prognostic and symptomatic benefits of myocardial revascularization depend on whether complete revascularization can be achieved. This needs to be considered when choosing the most appropriate revascularization strategy. In addition, the individual operative risk, the technical feasibility, the presence of diabetes mellitus and the anatomical complexity of coronary artery disease, as assessed by the SYNTAX score, are key criteria when choosing the optimal method of revascularization. For PCI radial artery access and the general use of drug-eluting stents are recommended. For CABG multiple arterial grafts should be strived for including the radial artery for treatment of high-grade coronary stenosis.
2018年发布的心肌血运重建指南是欧洲心脏病学会和欧洲心胸外科学会的联合倡议。为了确定经皮冠状动脉介入治疗（PCI）或冠状动脉旁路移植术（CABG）进行心肌血运重建的适应症，需要通过非侵入性成像功能测试或血管内血流动力学测量来证明冠状动脉狭窄的功能相关性。心肌血运重建的预后和症状改善益处取决于能否实现完全血运重建。在选择最合适的血运重建策略时需要考虑这一点。此外，个体手术风险、技术可行性、糖尿病的存在以及通过SYNTAX评分评估的冠状动脉疾病的解剖复杂性，是选择最佳血运重建方法时的关键标准。对于PCI，推荐桡动脉入路和药物洗脱支架的普遍使用。对于CABG，应争取使用多条动脉移植物，包括桡动脉，用于治疗严重冠状动脉狭窄。
