Casolo Giancarlo, Abrignani Maurizio Giuseppe, Amico Antonio Francesco, Cademartiri Filippo, Caporale Roberto, Di Lenarda Andrea, Domenicucci Stefano, Gabrielli Domenico, Geraci Giovanna, Indolfi Ciro, Limbruno Ugo, Midiri Massimo, Murrone Adriano, Musumeci Giuseppe, Nardi Federico, Nistri Stefano, Privitera Carmelo, Gulizia Michele Massimo
S.C. Cardiologia, Nuovo Ospedale Versilia, Lido di Camaiore (LU).
U.O. Cardiologia, Presidio Ospedaliero S. Antonio Abate, ASP 9, Erice (TP).
G Ital Cardiol (Rome). 2019 Jul-Aug;20(7):439-468. doi: 10.1714/3190.31688.
Both conventional coronary angiography and cardiac computed tomography have greatly improved our diagnostic and prognostic evaluation of patients with either suspected or confirmed coronary artery disease. Although several other tools can provide information about coronary anatomy or function, invasive coronary angiography and, more recently, coronary computed tomography angiography (CCTA) are the most commonly used imaging modalities. Coronary atherosclerosis is the most common disease of the coronary arteries and its presence identifies patients at increased risk of events. As a matter of fact, coronary atherosclerosis represents the major determinant for the occurrence of events and the development of ischemic heart disease. Coronary atherosclerosis can translate into plaques that may eventually progress to critical stenosis causing myocardial ischemia. More commonly, atherosclerotic lesions are non-obstructive. Their presence, number and extent negatively affect prognosis independently of other mechanisms. In order to improve prognosis, optimal medical therapy should be initiated to halt disease progression and/or to stabilize atherosclerotic plaques. It is therefore of paramount importance to describe the presence of atherosclerotic lesions well beyond those lesions potentially or undoubtedly capable of inducing myocardial ischemia. These latter lesions may in fact benefit from an interventional or surgical treatment. However, most events are caused by non-obstructive lesions that may often be missed.In common practice, the description of coronary anatomy is not structured in a universal model and each Center applies its own (albeit arbitrary) rules. This consensus document is a collaborative work of some of the major Italian Scientific Societies to offer scientific support to those healthcare professionals who, at different levels, report on coronary anatomy or receive the description of coronary anatomy of patients. After a brief description of the available techniques used to explore the coronary anatomy, the best available evidence in support of a detailed description of coronary atherosclerosis is summarized. In order to promote a useful translation of the information into practice, several recommendations for the correct reporting of coronary anatomy and the suggested treatment for the different clinical scenarios are provided. The aim of this consensus document is to refine the description of coronary anatomy as offered by both invasive coronary angiography and CCTA to improve risk stratification of patients undergoing coronary imaging in clinical practice and to select the most appropriate treatment for improving cardiovascular outcomes.
传统冠状动脉造影和心脏计算机断层扫描都极大地改善了我们对疑似或确诊冠心病患者的诊断和预后评估。尽管其他一些工具也能提供有关冠状动脉解剖结构或功能的信息，但侵入性冠状动脉造影以及最近的冠状动脉计算机断层扫描血管造影（CCTA）是最常用的成像方式。冠状动脉粥样硬化是冠状动脉最常见的疾病，其存在可识别出事件风险增加的患者。事实上，冠状动脉粥样硬化是事件发生和缺血性心脏病发展的主要决定因素。冠状动脉粥样硬化可转化为斑块，这些斑块最终可能进展为严重狭窄，导致心肌缺血。更常见的是，动脉粥样硬化病变并不阻塞血管。它们的存在、数量和范围独立于其他机制对预后产生负面影响。为了改善预后，应启动最佳药物治疗以阻止疾病进展和/或稳定动脉粥样硬化斑块。因此，描述动脉粥样硬化病变的存在，而不仅仅局限于那些可能或无疑会导致心肌缺血的病变，至关重要。事实上，后者可能受益于介入或手术治疗。然而，大多数事件是由常常被遗漏的非阻塞性病变引起的。在临床实践中，冠状动脉解剖结构的描述没有统一的模式，每个中心都应用自己（尽管是任意的）规则。本共识文件是一些意大利主要科学学会的合作成果，旨在为那些在不同层面报告冠状动脉解剖结构或接收患者冠状动脉解剖描述的医疗专业人员提供科学支持。在简要描述用于探索冠状动脉解剖结构的现有技术后，总结了支持详细描述冠状动脉粥样硬化的最佳现有证据。为了促进将这些信息有效地应用于实践，提供了一些关于正确报告冠状动脉解剖结构的建议以及针对不同临床情况的建议治疗方法。本共识文件的目的是完善侵入性冠状动脉造影和CCTA所提供的冠状动脉解剖结构描述，以改善临床实践中接受冠状动脉成像患者的风险分层，并选择最合适的治疗方法以改善心血管结局。
