Ahmad Yousif, Petrie Mark C, Jolicoeur E Marc, Madhavan Mahesh V, Velazquez Eric J, Moses Jeffrey W, Lansky Alexandra J, Stone Gregg W
Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut.
University of Glasgow, Glasgow, Scotland.
J Soc Cardiovasc Angiogr Interv. 2022 Apr 11;1(2):100020. doi: 10.1016/j.jscai.2022.100020. eCollection 2022 Mar-Apr.
Coronary artery disease (CAD) is the most common cause of left ventricular systolic dysfunction (LVSD) and heart failure (HF). Revascularization with coronary artery bypass grafting (CABG) reduces all-cause mortality compared with medical therapy alone for these patients. Despite this, CABG is performed in a minority of patients with HF, partly due to patient unwillingness or inability to undergo major cardiac surgery and partly due to physician reluctance to refer for surgery due to high operative risk. Percutaneous coronary intervention (PCI) is a less-invasive method of revascularization that has the potential to reduce periprocedural complications compared with CABG in patients with HF. Recent advances in PCI technology and technique have made it realistic to achieve more complete revascularization with PCI in high-risk patients with HF, although no randomized controlled clinical trials (RCTs) of PCI in HF compared with either medical therapy or CABG have been performed. In this review, we discuss the currently available evidence for PCI in HF and the association between the extent of revascularization and clinical outcomes in HF. We also review recent advances in PCI technology and techniques with the potential to improve clinical outcomes in HF. Finally, we discuss emerging clinical trial evidence of revascularization in HF and the large, persistent evidence gaps that should be addressed with future clinical trials of revascularization in HF.
冠状动脉疾病（CAD）是左心室收缩功能障碍（LVSD）和心力衰竭（HF）最常见的病因。与单纯药物治疗相比，冠状动脉旁路移植术（CABG）进行血运重建可降低这些患者的全因死亡率。尽管如此，接受CABG手术的HF患者仍占少数，部分原因是患者不愿或无法接受心脏大手术，部分原因是由于手术风险高，医生不愿推荐患者接受手术。经皮冠状动脉介入治疗（PCI）是一种侵入性较小的血运重建方法，与HF患者的CABG相比，它有可能减少围手术期并发症。尽管尚未进行与药物治疗或CABG相比的HF患者PCI随机对照临床试验（RCT），但PCI技术和技巧的最新进展已使在高危HF患者中通过PCI实现更完全的血运重建成为现实。在本综述中，我们讨论了目前HF患者PCI的现有证据以及血运重建程度与HF临床结局之间的关联。我们还回顾了PCI技术和技巧的最新进展，这些进展有可能改善HF的临床结局。最后，我们讨论了HF血运重建的新兴临床试验证据以及HF血运重建未来临床试验应解决的巨大且持续存在的证据空白。
