PERFUSE Study Group, Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 930 Commonwealth Ave, Boston, MA, 02215, USA.
ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université - Univ Paris 06 (UPMC), Paris, France.
Curr Cardiol Rep. 2019 Mar 13;21(4):26. doi: 10.1007/s11886-019-1108-x.
The last 40 years of clinical research in interventional cardiology were extraordinarily innovative. This article will review the most promising up and coming interventional cardiovascular therapies, with a primary focus on the treatment of coronary artery disease.
From the first stent, to the first transcatheter aortic valve implantation (TAVI), and the left appendage closure technique, percutaneous interventions revolutionized the treatment of multiple diseases and dramatically improved the prognosis of many patients. While these advances have decreased the risk of mortality in some patients (such as ST-elevation myocardial infarction), 15% of acute coronary syndrome (ACS) patients still experience recurrent ischemic events within the first year, challenging us to develop new pharmaceutical targets and new devices. The continued emergence of data supporting inflammation as a risk factor and pharmacologic target as well as data supporting the importance of cholesterol efflux have identified novel therapeutic targets that may play a major role in the improvement of prognosis of patients with coronary artery disease. In addition, novel medical devices are being developed to allow even earlier detection of acute cardiac events and to support high-risk percutaneous coronary interventions. Advances in computing and the ability to analyze large datasets will allow us to use artificial intelligence to augment the clinician patient experience, both in and out of the catheterization laboratory, with live procedural guidance as well as pre- and post-operative prognostication tools.
介入心脏病学近 40 年来的临床研究极具创新性。本文将回顾最有前途的新兴介入心血管治疗方法，主要关注冠心病的治疗。
从第一个支架到第一个经导管主动脉瓣置换术（TAVI）和左心耳封堵技术，经皮介入治疗彻底改变了多种疾病的治疗方法，并显著改善了许多患者的预后。虽然这些进展降低了某些患者（如 ST 段抬高型心肌梗死）的死亡率，但仍有 15%的急性冠脉综合征（ACS）患者在一年内发生复发性缺血事件，这促使我们开发新的药物靶点和新器械。越来越多的数据支持炎症是一个风险因素和药物靶点，以及胆固醇流出的重要性，这为识别新的治疗靶点提供了依据，这些靶点可能在改善冠心病患者的预后方面发挥重要作用。此外，正在开发新型医疗器械，以更早地检测急性心脏事件，并支持高危经皮冠状动脉介入治疗。计算技术的进步和分析大数据集的能力将使我们能够利用人工智能来增强临床医生的患者体验，无论是在导管室内外，都可以提供实时的程序性指导以及术前和术后预后工具。
