Montone Rocco A, Meucci Maria Chiara, Niccoli Giampaolo
Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Roma.
Fondazione Policlinico Universitario A. Gemelli IRCCS.
Eur Heart J Suppl. 2020 Nov 18;22(Suppl L):L170-L175. doi: 10.1093/eurheartj/suaa175. eCollection 2020 Nov.
About 50% of patients diagnosed with ST-segment elevation myocardial infarction have multivessel disease on coronary angiography. Recent evidence has shown that a staged percutaneous coronary intervention (PCI) strategy of non-culprit lesions, achieving complete revascularization, significantly reduces the rate of recurrent cardiovascular events compared with a PCI strategy limited to culprit lesion. Although functional evaluation of intermediate coronary stenoses by functional flow reserve (FFR) or instantaneous wave-free ratio (iFR) is widely used to detect residual myocardial ischaemia, the reliability of the study of non-culprit lesions in the acute phase of heart attack is controversial. On the other hand, the excess of new events in patients with acute coronary syndrome in whom PCI was deferred on the basis of FFR/iFR compared to patients with stable CAD could be due to both an inadequate functional evaluation and an intrinsic higher risk, related to the presence of untreated vulnerable plaques. In this context, intra-coronary imaging has shown that the presence of vulnerability features in non-culprit plaques is associated with an increased rate of ischaemic recurrence.
在经冠状动脉造影诊断为ST段抬高型心肌梗死的患者中，约50%患有多支血管病变。最近的证据表明，与仅针对罪犯病变的经皮冠状动脉介入治疗（PCI）策略相比，对非罪犯病变采取分期PCI策略以实现完全血运重建，可显著降低心血管事件复发率。尽管通过血流储备分数（FFR）或瞬时无波比值（iFR）对中度冠状动脉狭窄进行功能评估被广泛用于检测残余心肌缺血，但在心脏病发作急性期对非罪犯病变进行研究的可靠性仍存在争议。另一方面，与稳定型冠心病患者相比，基于FFR/iFR而推迟PCI的急性冠状动脉综合征患者出现更多新事件，这可能是由于功能评估不足以及与存在未治疗的易损斑块相关的内在较高风险所致。在此背景下，冠状动脉内成像显示，非罪犯斑块中存在易损特征与缺血复发率增加有关。
