Silber Sigmund
Kardiologische Praxis und Herzkatheter, Tal 21, 80331, München, Deutschland.
Herz. 2019 Dec;44(8):676-683. doi: 10.1007/s00059-019-04862-6.
After an unusually long period of time of 6 years, in August 2019 the updated version of the European Society of Cardiology (ESC) guidelines from 2013 on the management of stable coronary artery disease was published. The course of "stable" coronary artery disease is only assumed to be stable and pathologically is often progressive but initially goes unnoticed. In order to raise awareness for the progressive character of "stable" coronary artery disease, the term chronic coronary syndrome (CCS) was introduced. In this overview the various phenotypes of CCS are divided into three groups. 1) Suspected obstructive coronary artery disease: the emphasis here is on functional, noninvasive imaging diagnostics of ischemia and cardiac computed tomography (CT). These diagnostic options have become even more important in the light of the decreasing prevalence of coronary artery disease. 2) Known obstructive coronary artery disease: here there are many new practice-relevant recommendations, particularly in the field of pharmaceutical treatment with antithrombotic drugs. 3) Microvascular disease: in symptomatic patients the exclusion of epicardial coronary stenoses using invasive coronary angiography should not signify the end of the diagnostic procedure. Functional tests in the catheter laboratory should be initiated in order not to overlook a microvascular cause of the complaints and do an injustice to the patient.
在长达6年的异常漫长时间后，2019年8月，欧洲心脏病学会（ESC）于2013年发布的关于稳定型冠状动脉疾病管理的指南更新版本问世。“稳定型”冠状动脉疾病的病程仅被假定为稳定，而在病理上通常是进展性的，但起初未被察觉。为了提高对“稳定型”冠状动脉疾病进展特性的认识，引入了慢性冠状动脉综合征（CCS）这一术语。在本综述中，CCS的各种表型被分为三组。1）疑似阻塞性冠状动脉疾病：这里重点是缺血的功能性、非侵入性成像诊断以及心脏计算机断层扫描（CT）。鉴于冠状动脉疾病患病率的下降，这些诊断方法变得更加重要。2）已知阻塞性冠状动脉疾病：这里有许多与实践相关的新建议，特别是在抗血栓药物的药物治疗领域。3）微血管疾病：对于有症状的患者，使用侵入性冠状动脉造影排除心外膜冠状动脉狭窄不应意味着诊断程序的结束。应在导管实验室启动功能测试，以免忽视导致症状的微血管原因并对患者造成不公。
