Simone Fezzi, Daixin Ding, Felix Mahfoud, Jiayue Huang, Alexandra J. Lansky, Shengxian Tu, William Wijns
{"title":"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?","authors":"Simone Fezzi, Daixin Ding, Felix Mahfoud, Jiayue Huang, Alexandra J. Lansky, Shengxian Tu, William Wijns","doi":"10.1038/s41569-024-01014-0","DOIUrl":null,"url":null,"abstract":"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.","PeriodicalId":18976,"journal":{"name":"Nature Reviews Cardiology","volume":"21 9","pages":"652-662"},"PeriodicalIF":41.7000,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Illusion of revascularization: does anyone achieve optimal revascularization during percutaneous coronary intervention?\",\"authors\":\"Simone Fezzi, Daixin Ding, Felix Mahfoud, Jiayue Huang, Alexandra J. Lansky, Shengxian Tu, William Wijns\",\"doi\":\"10.1038/s41569-024-01014-0\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"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.\",\"PeriodicalId\":18976,\"journal\":{\"name\":\"Nature Reviews Cardiology\",\"volume\":\"21 9\",\"pages\":\"652-662\"},\"PeriodicalIF\":41.7000,\"publicationDate\":\"2024-05-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Nature Reviews Cardiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.nature.com/articles/s41569-024-01014-0\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Nature Reviews Cardiology","FirstCategoryId":"3","ListUrlMain":"https://www.nature.com/articles/s41569-024-01014-0","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
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.
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.