Achim Alexandru, Marc Madalin, Ruzsa Zoltan
"Niculae Stancioiu" Heart Institute, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania.
Klinik für Kardiologie, Medizinische Universitätsklinik, Kantonsspital Baselland, Liestal, Switzerland.
Front Cardiovasc Med. 2022 Apr 7;9:872398. doi: 10.3389/fcvm.2022.872398. eCollection 2022.
Current guidelines, rarely if at all, address decision-making for revascularization when bypass surgery is not a possibility for high-risk cases. Patients who are surgically turned down are routinely excluded from clinical trials, even though they remain symptomatic. Furthermore, the reasons for surgical ineligibility are often times not captured in standardized risk models. There is no data regarding health status outcomes following PCI procedures in these patients and the ultimate question remains whether the benefits of PCI outweigh its risks in this controversial subpopulation. When CHIP (Complex High risk Indicated Percutaneous coronary interventions) is selected for these very complex individuals, there is no unanimity regarding the goals for interventional revascularization (for instance, the ambition to achieve completeness of revascularization vs. more targeted or selective PCI). The recognition that, worldwide, these patients are becoming increasingly prevalent and increasingly commonplace in the cardiac catheterization labs, along with the momentum for more complex interventional procedures and expanding skillsets, gives us a timely opportunity to better examine the outcomes for these patients and inform clinical decision-making.
当前指南极少（即便有也几乎没有）涉及高风险病例无法进行搭桥手术时血管重建的决策制定。手术被拒绝的患者通常被排除在临床试验之外，尽管他们仍有症状。此外，手术不适合的原因在标准化风险模型中往往未被记录。对于这些患者接受经皮冠状动脉介入治疗（PCI）后的健康状况结果尚无数据，而最终的问题仍然是，在这个有争议的亚群体中，PCI的益处是否超过其风险。当为这些非常复杂的个体选择复杂高危指征经皮冠状动脉介入治疗（CHIP）时，对于介入性血管重建的目标（例如，实现血管重建完全性的目标与更具针对性或选择性的PCI）并没有一致意见。认识到在全球范围内，这些患者在心脏导管实验室中越来越普遍且越来越常见，再加上更复杂介入手术的发展势头和技能的不断拓展，这为我们提供了一个及时的机会，以便更好地研究这些患者的治疗结果并为临床决策提供依据。
