Cardiovascular Division, Guy's and St Thomas' NHS Foundation Trust, London, UK
British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King's College London, London, UK.
Open Heart. 2021 Nov;8(2). doi: 10.1136/openhrt-2021-001763.
How do we reduce cardiac death and myocardial infarction by percutaneous coronary intervention (PCI) in coronary heart disease? Although the interventional community continues to grapple with this question in stable angina, the benefits of PCI for non-culprit lesions found at ST-elevation myocardial infarction are established. Is it then wishful thinking that an index developed in stable coronary disease, for identifying lesions capable of causing ischaemia will show an incremental benefit over angiographically guided non-culprit PCI? This is the question posed by the recently published FLOW Evaluation to Guide Revascularization in Multi-vessel ST-elevation Myocardial Infarction (FLOWER-MI) trial. We examine the trial design and results; ask if there is any relationship between the baseline physiological significance of a non-culprit lesion and vulnerability to future myocardial infarction; and consider if more sophisticated methods can help guide or defer non-culprit revascularisation.
如何通过经皮冠状动脉介入治疗 (PCI) 降低冠心病患者的心脏死亡和心肌梗死发生率？尽管介入治疗领域仍在努力解决稳定型心绞痛患者的这一问题，但 ST 段抬高型心肌梗死中发现的非罪犯病变的 PCI 获益已得到证实。那么，在稳定型冠状动脉疾病中开发的一种用于识别可能导致缺血的病变的指标，是否会在血管造影指导的非罪犯 PCI 中显示出额外获益，这是否只是一厢情愿的想法？这就是最近发表的 FLOW Evaluation to Guide Revascularization in Multi-vessel ST-elevation Myocardial Infarction (FLOWER-MI) 试验提出的问题。我们将探讨该试验的设计和结果；询问非罪犯病变的基线生理意义与未来心肌梗死的易感性之间是否存在任何关系；并考虑是否可以采用更复杂的方法来指导或推迟非罪犯血运重建。
