血管再通的假象:是否有人在经皮冠状动脉介入治疗过程中实现了最佳血管再通?

IF 41.7 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Nature Reviews Cardiology Pub Date : 2024-05-07 DOI:10.1038/s41569-024-01014-0
Simone Fezzi, Daixin Ding, Felix Mahfoud, Jiayue Huang, Alexandra J. Lansky, Shengxian Tu, William Wijns
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引用次数: 0

摘要

这篇 "视角 "文章是一种 "模仿 "形式,灵感来自于 1993 年 Lincoff 和 Topol 题为 "再灌注的幻觉 "的评论,并探讨了他们的概念如何继续适用于冠心病和缺血患者的经皮血运重建。正如 Lincoff 和 Topol 在 1993 年认为急性心肌梗死的再灌注面临着尚未解决的障碍,这些障碍阻碍了临床成功,我们提出,具有挑战性的问题也同样危及着当今基于支架的血管成形术的潜在益处。通过分析经皮冠状动脉介入治疗(PCI)的适宜性和有效性,我们强调了单纯依赖可视血管造影引导的局限性,因为这种引导经常导致支架植入不当,多达三分之一的患者接受了过度治疗,并增加了围手术期心肌梗死的风险。在接受 PCI 治疗的患者中,有一半的患者没有得到最佳的血管再通,这就带来了风险,如 PCI 后的生理功能不达标、残留心绞痛和长期支架相关事件,估计有 76% 的患者存在 "血管再通假象"。这些结果凸显了我们需要完善诊断工具,将生理评估与有针对性的冠状动脉内成像和新兴策略(如联合注册系统和基于血管造影的人工智能计算方法)相结合,以实现最佳的血管再通效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Illusion of revascularization: does anyone achieve optimal revascularization during percutaneous coronary intervention?
This Perspective article is a form of ‘pastiche’, inspired by the 1993 review by Lincoff and Topol entitled ‘Illusion of reperfusion’, and explores how their concept continues to apply to percutaneous revascularization in patients with coronary artery disease and ischaemia. Just as Lincoff and Topol argued that reperfusion of acute myocardial infarction was facing unresolved obstacles that hampered clinical success in 1993, we propose that challenging issues are similarly jeopardizing the potential benefits of stent-based angioplasty today. By analysing the appropriateness and efficacy of percutaneous coronary intervention (PCI), we emphasize the limitations of relying solely on visual angiographic guidance, which frequently leads to inappropriate stenting and overtreatment in up to one-third of patients and the associated increased risk of periprocedural myocardial infarction. The lack of optimal revascularization observed in half of patients undergoing PCI confers risks such as suboptimal physiology after PCI, residual angina and long-term stent-related events, leaving an estimated 76% of patients with an ‘illusion of revascularization’. These outcomes highlight the need to refine our diagnostic tools by integrating physiological assessments with targeted intracoronary imaging and emerging strategies, such as co-registration systems and angiography-based computational methods enhanced by artificial intelligence, to achieve optimal revascularization outcomes. In 1993, Lincoff and Topol claimed that the thrombolytic treatment of ST-segment elevation myocardial infarction was suboptimal in many patients and gave an ‘illusion of reperfusion’. In this Perspective article, the authors propose that a similar illusion of revascularization exists for contemporary percutaneous revascularization in patients with coronary artery disease and ischaemia, and identify how outcomes might be improved.
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来源期刊
Nature Reviews Cardiology
Nature Reviews Cardiology 医学-心血管系统
CiteScore
53.10
自引率
0.60%
发文量
143
审稿时长
6-12 weeks
期刊介绍: Nature Reviews Cardiology aims to be the go-to source for reviews and commentaries in the scientific and clinical communities it serves. Focused on providing authoritative and accessible articles enriched with clear figures and tables, the journal strives to offer unparalleled service to authors, referees, and readers, maximizing the usefulness and impact of each publication. It covers a broad range of content types, including Research Highlights, Comments, News & Views, Reviews, Consensus Statements, and Perspectives, catering to practising cardiologists and cardiovascular research scientists. Authored by renowned clinicians, academics, and researchers, the content targets readers in the biological and medical sciences, ensuring accessibility across various disciplines. In-depth Reviews offer up-to-date information, while Consensus Statements provide evidence-based recommendations. Perspectives and News & Views present topical discussions and opinions, and the Research Highlights section filters primary research from cardiovascular and general medical journals. As part of the Nature Reviews portfolio, Nature Reviews Cardiology maintains high standards and a wide reach.
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