OUR PREOCCUPATION WITH CORONARY LUMINOLOGY - THE DISSOCIATION BETWEEN CLINICAL AND ANGIOGRAPHIC FINDINGS IN ISCHEMIC-HEART-DISEASE
OUR PREOCCUPATION WITH CORONARY LUMINOLOGY - THE DISSOCIATION BETWEEN CLINICAL AND ANGIOGRAPHIC FINDINGS IN ISCHEMIC-HEART-DISEASE
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DOI：
10.1161/01.cir.92.8.2333
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发表时间：
1995-10-15
期刊：
影响因子：
37.8
通讯作者：
NISSEN, SE
中科院分区：
文献类型：
--
作者：
TOPOL, EJ;NISSEN, SE
在其发明近40年后，血管造影仍然被大多数医生认为是定义冠状动脉解剖结构的“黄金标准”。仔细的调查显示，这种方法有许多固有的缺陷。本文的目的是概述我们目前对冠状动脉“发光学”的关注可能被误导的证据，并为未来的实践和调查提出一个合理的范式。血管造影术从管腔的平面二维轮廓描绘冠状动脉解剖结构。血管造影术的分辨率被限制在每毫米四或五个线对。混杂因素包括血管迂曲度、结构重叠和管腔形状的影响。干预后，模糊、变宽的轮廓可能会高估管腔尺寸的实际增益。研究表明，病变的表观严重程度与其生理影响之间存在显着差异。心肌梗死后，心脏病专家在进行经皮冠状动脉血运重建术前往往不尝试证明狭窄的生理意义。同样，使用新的介入设备进行更好、更令人满意的血管造影的吸引力似乎是其受欢迎的主导因素。介入心脏病专家应该意识到，能够产生显著血管造影获益的技术也可能产生重要但未被识别的危害。血管造影和临床结果之间的分离应该影响未来的研究工作。我们的文献回顾表明，我们可能会受益于转移目前的重点和专注于冠状动脉发光学，以实现预期的临床终点：提高生存率和长期无心肌梗死和冠心病的致残症状。
Nearly 40 years after its invention, the angiogram is still considered by most physicians to be the ''gold standard'' for defining coronary anatomy. Careful investigations have revealed many deficiencies inherent in this approach. The purpose of this article is to outline the evidence that our current preoccupation with coronary ''luminology'' may be misguided and to propose a rational paradigm for future practice and investigation. Angiography depicts coronary anatomy from a planar two-dimensional silhouette of the lumen. Angiography is limited in resolution to four or five line pairs per millimeter. Confounding factors include vessel tortuosity, overlap of structures, and the effects of lumen shape. After intervention, a hazy, broadened silhouette may overestimate the actual gain in lumen size. Studies show marked disparity between the apparent severity of lesions and their physiological effects. After myocardial infarction, cardiologists too often do not make an attempt to demonstrate the physiological significance of the stenosis before performing percutaneous coronary revascularization. Similarly, the allure of a better, more gratifying angiogram with new interventional devices appears to be a dominant factor in their popularity. Interventional cardiologists should be aware that techniques yielding marked angiographic benefit may also generate important but unrecognized hazards. The dissociation between the angiogram and clinical outcome should influence future research efforts. Our review of the literature indicates that we may benefit from shifting the current focus and preoccupation with coronary luminology to achieving the desired clinical end point: promoting survival and long-term freedom from myocardial infarction and the disabling symptoms of coronary heart disease.