Li Kam Wa Matthew E, Assar Saba Z, Kirtane Ajay J, Perera Divaka
Coronary Research Group, British Heart Foundation Centre of Research Excellence, King's College London London, UK.
Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital New York, NY, US.
Interv Cardiol. 2023 Aug 1;18:e24. doi: 10.15420/icr.2023.06. eCollection 2023.
Coronary artery disease is a leading cause of heart failure with reduced ejection fraction. Coronary artery bypass grafting appears to provide clinical benefits such as improvements in quality of life, reductions in readmissions and MI, and favourable effects on long-term mortality; however, there is a significant short-term procedural risk when left ventricular function is severely impaired, which poses a conundrum for many patients. Could percutaneous coronary intervention provide the same benefits without the hazard of surgery? There have been no randomised studies to support this practice until recently. The REVIVED-BCIS2 trial (NCT01920048) assessed the outcomes of percutaneous coronary intervention in addition to optimal medical therapy in patients with ischaemic left ventricular dysfunction and stable coronary artery disease. This review examines the trial results in detail, suggests a pathway for investigation and revascularisation in ischaemic cardiomyopathy, and explores some of the remaining unanswered questions.
冠状动脉疾病是射血分数降低的心力衰竭的主要原因。冠状动脉旁路移植术似乎能带来临床益处，如改善生活质量、减少再入院率和心肌梗死，以及对长期死亡率产生有利影响；然而，当左心室功能严重受损时，手术存在显著的短期风险，这给许多患者带来了难题。经皮冠状动脉介入治疗能否在不具有手术风险的情况下提供同样的益处？直到最近才有随机研究支持这种做法。REVIVED-BCIS2试验（NCT01920048）评估了在缺血性左心室功能障碍和稳定冠状动脉疾病患者中，除了最佳药物治疗外进行经皮冠状动脉介入治疗的结果。本综述详细研究了试验结果，提出了缺血性心肌病的研究和血运重建途径，并探讨了一些仍未得到解答的问题。
