Gould K L
The Weatherhead PET Center for Preventing or Reversing Heart and Vascular Disease, University of Texas Medical School, Houston, Texas 77030, USA.
Am J Cardiol. 1998 Sep 24;82(6A):12M-21M. doi: 10.1016/s0002-9149(98)00592-x.
Coronary arteriography has played a central role in improving our understanding of the mechanisms of unstable coronary syndromes and the benefits of cholesterol lowering. However, coronary arteriography as currently used is outmoded and inadequate for new clinical algorithms based on vigorous lipid and other risk factor control as alternatives to invasive procedures for the primary treatment of coronary artery disease. What is needed is a way of viewing or analyzing noninvasive myocardial perfusion images and coronary arteriograms so as to identify and quantify the extent or severity of diffuse coronary atherosclerosis. Determining the relative contribution of diffuse and segmental narrowing by definitive myocardial perfusion imaging or coronary arteriography would provide the optimal basis for determining the need for revascularization procedures. In the absence of significant segmental stenoses, mild or diffuse disease identified by coronary arteriography would also provide a definitive diagnosis as the basis for lifelong cholesterol-lowering drugs and risk factor modification, even for patients with normal cholesterol levels. Thus, it is important to consider several new concepts for analyzing coronary arteriograms. More physiologically accurate invasive and noninvasive technology allows improved diagnosis and management of coronary atherosclerosis as new paradigms in cardiovascular medicine.
冠状动脉造影在增进我们对不稳定型冠状动脉综合征机制以及降低胆固醇益处的理解方面发挥了核心作用。然而，目前所使用的冠状动脉造影已过时，对于基于积极控制血脂及其他危险因素作为冠状动脉疾病初始治疗替代侵入性手术的新临床算法而言并不适用。所需要的是一种查看或分析无创心肌灌注图像和冠状动脉造影的方法，以便识别和量化弥漫性冠状动脉粥样硬化的范围或严重程度。通过确定性心肌灌注成像或冠状动脉造影确定弥漫性和节段性狭窄的相对贡献，将为确定血运重建手术的必要性提供最佳依据。在不存在明显节段性狭窄的情况下，冠状动脉造影所识别出的轻度或弥漫性疾病也将提供明确诊断，作为终身服用降胆固醇药物和调整危险因素的依据，即使对于胆固醇水平正常的患者也是如此。因此，考虑一些分析冠状动脉造影的新概念很重要。更符合生理准确性的侵入性和非侵入性技术能够改善冠状动脉粥样硬化的诊断和管理，成为心血管医学的新范例。
