Marzilli Mario, Crea Filippo, Morrone Doralisa, Bonow Robert O, Brown David L, Camici Paolo G, Chilian William M, DeMaria Anthony, Guarini Giacinta, Huqi Alda, Merz C Noel Bairey, Pepine Carl, Scali Maria Chiara, Weintraub William S, Boden William E
Department of Surgery, Medical, Molecular and Critical Area Pathology, University of Pisa, Italy.
Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
Int J Cardiol. 2020 Sep 1;314:32-35. doi: 10.1016/j.ijcard.2020.04.074. Epub 2020 Apr 26.
Although current guidelines on the management of stable coronary artery disease acknowledge that multiple mechanisms may precipitate myocardial ischemia, recommended diagnostic, prognostic and therapeutic algorithms are still focused on obstructive epicardial atherosclerotic lesions, and little progress has been made in identifying management strategies for non-atherosclerotic causes of myocardial ischemia. The purpose of this consensus paper is three-fold: 1) to marshal scientific evidence that obstructive atherosclerosis can co-exist with other mechanisms of ischemic heart disease (IHD); 2) to explore how the awareness of multiple precipitating mechanisms could impact on pre-test probability, provocative test results and treatment strategies; and 3) to stimulate a more comprehensive approach to chronic myocardial ischemic syndromes, consistent with the new understanding of this condition.
尽管当前关于稳定型冠状动脉疾病管理的指南承认多种机制可能引发心肌缺血，但推荐的诊断、预后和治疗算法仍聚焦于阻塞性心外膜动脉粥样硬化病变，在确定非动脉粥样硬化性心肌缺血病因的管理策略方面进展甚微。本共识文件的目的有三个：1）整理科学证据，证明阻塞性动脉粥样硬化可与其他缺血性心脏病（IHD）机制共存；2）探讨认识多种诱发机制如何影响检测前概率、激发试验结果和治疗策略；3）激发对慢性心肌缺血综合征采取更全面方法，与对该病症的新认识相一致。
