Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañon, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.
Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañon, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; Department of Bioengineering and Aerospace Engineering, Universidad Carlos III, Madrid, Spain.
Trends Cardiovasc Med. 2020 Aug;30(6):346-352. doi: 10.1016/j.tcm.2019.08.011. Epub 2019 Sep 6.
Approximately 30-50% of patients with ST-segment elevation acute myocardial infarction have multivessel disease. The physiology of the non-culprit artery (NCA) is complex and represents a challenge to physicians as, while these plaques are presumably stable, clinical data show that they frequently lead to major adverse cardiovascular events. In addition the presence of microvascular and endothelial dysfunction may have prognostic implications and interfere with current physiological indices for stenosis severity assessment. In this review we aim to summarize current methods to study the microcirculation, discuss the evidence available regarding the endothelium and the microvascular compartment of the NCA; the best strategies to perform a complete revascularization based on proven ischemia; real limitations associated to hyperemic stenosis indices; and the potential role of novel resting-indices in this specific acute context.
约 30-50% 的 ST 段抬高型急性心肌梗死患者存在多支血管病变。非罪犯血管（NCA）的生理学较为复杂，这对医生来说是一个挑战，因为尽管这些斑块可能稳定，但临床数据显示它们经常导致主要不良心血管事件。此外，微血管和内皮功能障碍的存在可能具有预后意义，并干扰目前用于评估狭窄严重程度的生理指标。在这篇综述中，我们旨在总结目前研究微循环的方法，讨论有关 NCA 内皮和微血管腔的现有证据；基于已证实的缺血情况进行完全血运重建的最佳策略；与充血性狭窄指数相关的实际局限性；以及在这种特定的急性情况下新型静息指数的潜在作用。
