Kanyal Ritesh, Byrne Jonathan
King's College Hospital NHS Foundation Trust, London, UK.
JRSM Cardiovasc Dis. 2021 Oct 19;10:20480040211014064. doi: 10.1177/20480040211014064. eCollection 2021 Jan-Dec.
The practice of interventional cardiology has changed dramatically over the last four decades since Andreas Gruentzig carried out the first balloon angioplasty. The obvious technological improvements in stent design and interventional techniques have facilitated the routine treatment of a higher risk cohort of patients, including those with complex coronary artery disease and poor left ventricular function, and more often in the setting of cardiogenic shock (CS) complicating acute myocardial infarction (AMI). The use of mechanical cardiac support (MCS) in these settings has been the subject of intense interest, particularly over the past decade . A number of commercially available devices now add to the interventional cardiologist's armamentarium when faced with the critically unwell or high-risk patient in the cardiac catheter laboratory. The theoretical advantage of such devices in these settings is clear- an increase in cardiac output and hence mean arterial pressure, with variable effects on coronary blood flow. In doing so, they have the potential to prevent the downward cascade of ischaemia and hypoperfusion, but there is a paucity of evidence to support their routine use in any patient subset, even those presenting with cardiogenic shock. This review will discuss the use and haemodynamic effect of MCS devices during percutaneous coronary intervention (PCI), and also examine the clinical evidence for their use in patients with cardiogenic shock, and those undergoing 'high risk' PCI.
自安德烈亚斯·格伦齐格进行首例球囊血管成形术以来的过去四十年里，介入心脏病学实践发生了巨大变化。支架设计和介入技术的显著技术改进促进了对更高风险患者群体的常规治疗，包括那些患有复杂冠状动脉疾病和左心室功能不佳的患者，而且在急性心肌梗死（AMI）并发心源性休克（CS）的情况下更为常见。在这些情况下使用机械心脏支持（MCS）一直是人们密切关注的主题，尤其是在过去十年。现在，当心脏导管实验室面对病情危急或高风险的患者时，一些市售设备增加了介入心脏病专家的可用手段。此类设备在这些情况下的理论优势很明显——心输出量增加，进而平均动脉压升高，对冠状动脉血流有不同影响。这样做，它们有可能防止缺血和低灌注的下行级联反应，但缺乏证据支持在任何患者亚组中常规使用它们，即使是那些出现心源性休克的患者。本综述将讨论MCS设备在经皮冠状动脉介入治疗（PCI）期间的使用和血流动力学效应，还将研究其在心源性休克患者和接受“高风险”PCI患者中使用的临床证据。
