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已确诊慢性冠状动脉综合征患者的血运重建策略。

Revascularization strategies for patients with established chronic coronary syndrome.

机构信息

Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.

Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.

出版信息

Eur J Clin Invest. 2022 Aug;52(8):e13787. doi: 10.1111/eci.13787. Epub 2022 Apr 29.

Abstract

Coronary artery disease is the most common type of cardiovascular disease, leading to high mortality rates worldwide. Although the vast majority can be treated effectively and safely by medical therapy, revascularization strategies remain essential for numerous patients. Outcomes of both percutaneous coronary intervention and coronary artery bypass grafting improve in a rapid pace, resulting from technical innovation and ongoing research. Progress has been achieved by technical improvements in coronary stents, optimal coronary target and graft selection, and the availability of minimally invasive surgical strategies. Besides technical progress, evidence-based patient-tailored decision-making by the Heart Team is the basic precondition for optimal outcome. The combination of fast innovation and long-term clinical evaluations creates a dynamic field. Research outcomes should be carefully interpreted according to the techniques used and the trial's design. Therefore, more and more trial outcomes suggest that revascularization strategies should be tailored towards the specific patient. Although the European Society of Cardiology/European Association for Cardio-Thoracic Surgery guidelines on myocardial revascularization date from 2018 and a large variety of trial outcomes on revascularization strategies in chronic coronary syndrome have been published since, we aim to provide an updated overview within this review.

摘要

冠状动脉疾病是最常见的心血管疾病,导致全球死亡率居高不下。尽管绝大多数患者可以通过药物治疗得到有效和安全的治疗,但血管重建策略对许多患者仍然至关重要。经皮冠状动脉介入治疗和冠状动脉旁路移植术的疗效都在迅速提高,这得益于技术创新和持续的研究。冠状动脉支架技术的改进、最佳冠状动脉靶区和移植物选择以及微创外科策略的应用,都取得了进展。除了技术进步,心脏团队的循证个体化决策是获得最佳疗效的基本前提。快速创新和长期临床评估的结合创造了一个充满活力的领域。研究结果应根据所使用的技术和试验设计进行仔细解读。因此,越来越多的试验结果表明,血管重建策略应针对特定患者进行个体化制定。尽管 2018 年欧洲心脏病学会/欧洲心胸外科学会心肌血运重建指南已经发布,并且自那时以来已经发表了大量关于慢性冠状动脉综合征血管重建策略的试验结果,但我们旨在通过本综述提供一个更新的概述。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6682/9539712/14d3f6b564c8/ECI-52-e13787-g001.jpg

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