Montone Rocco A, Niccoli Giampaolo, Crea Filippo, Jang Ik-Kyung
Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli, 1-00168 Rome, Italy.
Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy.
Eur Heart J. 2020 Oct 1;41(37):3579-3586. doi: 10.1093/eurheartj/ehaa481.
Approximately 50% of patients with ST-segment elevation myocardial infarction (STEMI) have multivessel coronary artery disease, a condition associated with an increased incidence of recurrent ischaemic events and higher mortality. Based on recent evidences, a strategy of staged percutaneous coronary intervention (PCI) of obstructive non-culprit lesions should be considered the gold standard for the management of these patients. However, several issues remain still unresolved. Indeed, what is the optimal timing of staged PCI is not completely defined. Moreover, assessment of intermediate non-culprit lesions represent still a clinical conundrum, as pressure-wire indexes do not seem able to correctly identify those patients in whom deferral is safe. Intracoronary imaging may help to identify untreated non-culprit lesions containing vulnerable plaques that may portend a higher risk of future cardiovascular events. However, there are hitherto no studies demonstrating that preventive PCI of vulnerable plaques or more intensive pharmacological treatment is associated with an improved clinical outcome. In this review, we discuss the recent evolving concepts about management of non-culprit plaques in STEMI patients, proposing a diagnostic and therapeutic algorithm to guide physicians in clinical practice. We also underscore the several knowledge gaps to address in future studies.
约50%的ST段抬高型心肌梗死（STEMI）患者患有多支冠状动脉疾病，这种情况与复发性缺血事件发生率增加及死亡率升高相关。基于近期证据，对于这些患者的管理，分期经皮冠状动脉介入治疗（PCI）阻塞性非罪犯病变的策略应被视为金标准。然而，仍有几个问题尚未解决。事实上，分期PCI的最佳时机尚未完全明确。此外，对中间非罪犯病变的评估仍是一个临床难题，因为压力导丝指标似乎无法正确识别那些延迟治疗安全的患者。冠状动脉内成像可能有助于识别含有易损斑块的未治疗非罪犯病变，这些病变可能预示着未来心血管事件的更高风险。然而，迄今为止尚无研究表明对易损斑块进行预防性PCI或更强化的药物治疗与改善临床结局相关。在本综述中，我们讨论了STEMI患者非罪犯斑块管理方面的最新演变概念，提出了一种诊断和治疗算法以指导临床医生的实践。我们还强调了未来研究中需要解决的几个知识空白。
