Schäfer Andreas, Alasnag Mirvat, Giacoppo Daniele, Collet Carlos, Rudolph Tanja K, Roguin Ariel, Buszman Piotr P, Colleran Roisin, Stefanini Giulio, Lefevre Thierry, Mieghem Nicolas Van, Cayla Guillaume, Naber Christoph, Baumbach Andreas, Witkowski Adam, Burzotta Francesco, Capodanno Davide, Dudek Dariusz, Al-Lamee Rasha, Banning Adrian, MacCarthy Philip, Gottardi Roman, Schoenhoff Florian S, Czerny Martin, Thielmann Matthias, Werner Nikos, Tarantini Giuseppe
Cardiac Arrest Center, Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany.
Cardiac Center, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia.
EuroIntervention. 2025 Jan 6;21(1):22-34. doi: 10.4244/EIJ-D-23-01100.
This clinical consensus statement of the European Association of Percutaneous Cardiovascular Interventions was developed in association with the European Society of Cardiology Working Group on Cardiovascular Surgery. It aims to define procedural and contemporary technical requirements that may improve the efficacy and safety of percutaneous coronary intervention (PCI), both in the acute phase and at long-term follow-up, in a high-risk cohort of patients on optimal medical therapy when clinical and anatomical high-risk criteria are present that entail unacceptable surgical risks, precluding the feasibility of coronary artery bypass grafting (CABG). This document pertains to patients with surgical contraindication according to the Heart Team, in whom medical therapy has failed (e.g., residual symptoms), and for whom the Heart Team estimates that revascularisation may have a prognostic benefit (e.g., left main, last remaining vessel, multivessel disease with large areas of ischaemia); however, there is a lack of data regarding the size of this patient population. This document aims to guide interventional cardiologists on how to proceed with PCI in such high-risk patients with reduced left ventricular ejection fraction after the decision of the Heart Team is made that CABG - which overall is the guideline-recommended option for revascularisation in these patients - is not an option and that PCI may be beneficial for the patient. Importantly, when a high-risk PCI is planned, a multidisciplinary decision by interventional cardiologists, cardiac surgeons, anaesthetists and non-invasive physicians with expertise in heart failure management and intensive care should be agreed upon after careful consideration of the possible undesirable consequences of PCI, including futility, similar to the approach for structural interventions.
欧洲经皮心血管介入协会的这份临床共识声明是与欧洲心脏病学会心血管外科工作组联合制定的。其目的是确定在急性期和长期随访中，对于接受最佳药物治疗的高风险患者队列，当存在临床和解剖学高风险标准导致不可接受的手术风险、排除冠状动脉旁路移植术（CABG）可行性时，可能提高经皮冠状动脉介入治疗（PCI）疗效和安全性的操作及当代技术要求。本文件适用于根据心脏团队评估手术存在禁忌证的患者，这些患者药物治疗失败（如仍有残余症状），且心脏团队估计血运重建可能具有预后益处（如左主干病变、最后剩余血管病变、大面积缺血的多支血管病变）；然而，目前缺乏关于这一患者群体规模的数据。本文件旨在指导介入心脏病专家，在心脏团队做出决定，认为CABG（总体而言是这些患者血运重建的指南推荐选择）不可行且PCI可能对患者有益之后，如何对左心室射血分数降低的此类高风险患者进行PCI。重要的是，在计划进行高风险PCI时，介入心脏病专家、心脏外科医生、麻醉师以及在心力衰竭管理和重症监护方面具有专业知识的非侵入性医生应在仔细考虑PCI可能产生的不良后果（包括无效治疗）后，达成多学科决策，这类似于结构性介入的方法。
