Asleh Rabea, Resar Jon R
Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
J Clin Med. 2019 Aug 13;8(8):1209. doi: 10.3390/jcm8081209.
Given the tremendous progress in interventional cardiology over the last decade, a growing number of older patients, who have more comorbidities and more complex coronary artery disease, are being considered for technically challenging and high-risk percutaneous coronary interventions (PCI). The success of performing such complex PCI is increasingly dependent on the availability and improvement of mechanical circulatory support (MCS) devices, which aim to provide hemodynamic support and left ventricular (LV) unloading to enable safe and successful coronary revascularization. MCS as an adjunct to high-risk PCI may, therefore, be an important component for improvement in clinical outcomes. MCS devices in this setting can be used for two main clinical conditions: patients who present with cardiogenic shock complicating acute myocardial infarction (AMI) and those undergoing technically complex and high-risk PCI without having overt cardiogenic shock. The current article reviews the advancement in the use of various devices in both AMI complicated by cardiogenic shock and complex high-risk PCI, highlights the available hemodynamic and clinical data associated with the use of MCS devices, and presents suggestive management strategies focusing on appropriate patient selection and optimal timing and support to potentially increase the clinical benefit from utilizing these devices during PCI in this high-risk group of patients.
鉴于过去十年间介入心脏病学取得了巨大进展，越来越多合并症更多、冠状动脉疾病更复杂的老年患者正在考虑接受技术难度大且风险高的经皮冠状动脉介入治疗（PCI）。实施此类复杂PCI的成功越来越依赖于机械循环支持（MCS）设备的可用性和改进，这些设备旨在提供血流动力学支持和左心室（LV）减负，以实现安全且成功的冠状动脉血运重建。因此，MCS作为高危PCI的辅助手段，可能是改善临床结局的重要组成部分。在此背景下，MCS设备可用于两种主要临床情况：出现心源性休克并发急性心肌梗死（AMI）的患者，以及接受技术复杂且高危PCI但无明显心源性休克的患者。本文综述了在AMI并发心源性休克和复杂高危PCI中使用各种设备的进展，强调了与使用MCS设备相关的可用血流动力学和临床数据，并提出了针对性的管理策略，重点在于适当的患者选择、最佳时机和支持，以潜在增加在这一高危患者群体的PCI过程中使用这些设备的临床获益。
