Suppr超能文献

冠状动脉血运重建的现状:经皮冠状动脉介入治疗与冠状动脉旁路移植术

The Current State of Coronary Revascularization: Percutaneous Coronary Intervention versus Coronary Artery Bypass Graft Surgery.

作者信息

Brown Matthew A, Klusewitz Seth, Elefteriades John, Prescher Lindsey

机构信息

Department of Cardiac Surgery, Georgetown University School of Medicine, Washington, District of Columbia.

Department of Cardiology, Walter Reed National Military Medical Center, Bethesda, Maryland.

出版信息

Int J Angiol. 2021 Nov 10;30(3):228-242. doi: 10.1055/s-0041-1735591. eCollection 2021 Sep.

Abstract

The question of percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) surgery remains among the most important questions in the treatment of coronary artery disease. The leading North American and European societies largely agree on the current guidelines for the revascularization of unprotected left-main disease (ULMD) and multivessel disease (MVD) which are largely supported by the outcomes of several large randomized trials including SYNTAX, PRECOMBAT, NOBLE, and EXCEL. While these trials are of the highest quality, currently available, they suffer several limitations, including the use of bare metal and/or first-generation drug-eluting stents in early trials and lack of updated surgical outcomes data. The objective of this review is to briefly discuss these key early trials, as well as explore contemporary studies, to provide insight on the current state of coronary revascularization. Evidence suggests that in ULMD and MVD, there are similar mortality rates for CABG and PCI but PCI is associated with fewer "early" strokes, whereas CABG is associated with fewer "late" strokes, myocardial infarctions, and lower need for repeat revascularization. Additionally, studies suggest that CABG remains superior to PCI in patients with intermediate/high SYNTAX scores and in MVD with concomitant proximal left anterior descending (pLAD) artery stenosis. Despite the preceding research and its basis for our current guidelines, there remains significant variation in care that has yet to be quantified. Emerging studies evaluating second-generation drug-eluting stents, specific lesion anatomy, and minimally invasive and hybrid approaches to CABG may lend itself to more individualized patient care.

摘要

经皮冠状动脉介入治疗(PCI)与冠状动脉旁路移植术(CABG)孰优孰劣,仍是冠状动脉疾病治疗领域最重要的问题之一。北美和欧洲的主要学会在很大程度上就目前无保护左主干病变(ULMD)和多支血管病变(MVD)血运重建的指南达成了一致,这些指南在很大程度上得到了包括SYNTAX、PRECOMBAT、NOBLE和EXCEL等多项大型随机试验结果的支持。虽然这些试验是目前可获得的质量最高的试验,但它们存在一些局限性,包括早期试验中使用裸金属支架和/或第一代药物洗脱支架,以及缺乏更新的手术结果数据。本综述的目的是简要讨论这些关键的早期试验,并探讨当代研究,以深入了解冠状动脉血运重建的现状。有证据表明,在ULMD和MVD中,CABG和PCI的死亡率相似,但PCI与较少的“早期”中风相关,而CABG与较少的“晚期”中风、心肌梗死以及较低的再次血运重建需求相关。此外,研究表明,在SYNTAX评分中/高的患者以及伴有左前降支近端(pLAD)动脉狭窄的MVD患者中,CABG仍优于PCI。尽管有上述研究及其作为我们当前指南的基础,但治疗方面仍存在显著差异,尚未进行量化。评估第二代药物洗脱支架、特定病变解剖结构以及CABG的微创和杂交方法的新兴研究,可能有助于实现更个体化的患者护理。

相似文献

1
The Current State of Coronary Revascularization: Percutaneous Coronary Intervention versus Coronary Artery Bypass Graft Surgery.
Int J Angiol. 2021 Nov 10;30(3):228-242. doi: 10.1055/s-0041-1735591. eCollection 2021 Sep.
2
Stroke Rates Following Surgical Versus Percutaneous Coronary Revascularization.
J Am Coll Cardiol. 2018 Jul 24;72(4):386-398. doi: 10.1016/j.jacc.2018.04.071.

引用本文的文献

1
Guidezilla™ guide extension catheter I for transradial coronary intervention.
Front Cardiovasc Med. 2022 Aug 17;9:931373. doi: 10.3389/fcvm.2022.931373. eCollection 2022.

本文引用的文献

1
Therapeutic Options for Left Main, Left Main Equivalent, and Three-Vessel Disease.
Int J Angiol. 2021 Mar;30(1):76-82. doi: 10.1055/s-0041-1723977. Epub 2021 Feb 12.
2
Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association.
Circulation. 2021 Feb 23;143(8):e254-e743. doi: 10.1161/CIR.0000000000000950. Epub 2021 Jan 27.
3
Long-Term Outcomes After PCI or CABG for Left Main Coronary Artery Disease According to Lesion Location.
JACC Cardiovasc Interv. 2020 Dec 28;13(24):2825-2836. doi: 10.1016/j.jcin.2020.08.021.
4
Revascularization for Isolated Proximal Left Anterior Descending Artery Disease.
Ann Thorac Surg. 2021 Aug;112(2):555-562. doi: 10.1016/j.athoracsur.2020.08.049. Epub 2020 Nov 2.
6
Percutaneous Intervention or Bypass Graft for Left Main Coronary Artery Disease? A Systematic Review and Meta-Analysis.
J Interv Cardiol. 2020 Jul 26;2020:4081642. doi: 10.1155/2020/4081642. eCollection 2020.
10
Initial Invasive or Conservative Strategy for Stable Coronary Disease.
N Engl J Med. 2020 Apr 9;382(15):1395-1407. doi: 10.1056/NEJMoa1915922. Epub 2020 Mar 30.

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍。

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索

文档翻译

学术文献翻译模型,支持多种主流文档格式。

立即体验