Multi-vessel coronary disease and percutaneous coronary intervention
Multi-vessel coronary disease and percutaneous coronary intervention
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DOI：
10.1136/hrt.2003.018986
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发表时间：
2004-03-01
期刊：
影响因子：
5.7
通讯作者：
Faxon, DP
中科院分区：
文献类型：
--
作者：
Casey, C;Faxon, DP
Andreas Gruentzig 25 年前，他设想该手术是一种可以延迟进行 CABG 的技术，直到出现严重的多支血管疾病为止。多年来，设备和装置的技术进步提高了安全性以及短期和长期成果。这极大地扩展了该技术的适应症，并使更多的动脉能够接受有效的治疗，从而获得更好的患者预后。此外，辅助药物治疗的发展进一步改善了经皮手术的结果。 20世纪90年代许多大型试验的结果表明，对于多支冠状动脉疾病患者来说，与“金标准”CABG相比，经皮介入治疗同样可以取得成功。如今，随着包括药物洗脱支架在内的冠状动脉支架技术的进步，多支血管成形术将取得又一次飞跃，适应症进一步扩大，预后得到改善。大约三分之二需要血运重建的患者患有多血管疾病，其中三分之二的解剖结构适合经皮或心脏直视手术治疗。 1 两种技术均已被证明在缓解心绞痛方面相对安全且高效，并且死亡率和心肌梗死率相似；然而，所有主要研究都表明，接受心脏直视手术的患者中额外的血运重建手术较少。 1 人们普遍预计，随着药物洗脱支架的出现，重复手术的差距可能会开始缩小。
Andreas Gruentzig 25 years ago, he envisioned the procedure to be a technique that would delay the need for CABG until severe multi-vessel coronary disease was present. Over the years, technological advances in equipment and devices have improved safety as well as short and long term outcomes. This has greatly expanded the indications for the technique and allowed more arteries to be accessible to effective treatment with better patient outcomes. In addition, developments in adjuvant pharmacotherapy have further improved outcomes of percutaneous procedures. The results of many large trials in the 1990s have shown that percutaneous intervention can be equally successful when compared to the ‘‘gold standard’’CABG for patients with multi-vessel coronary artery disease. Now with advances in coronary stent technology, including drug eluting stents, multi-vessel angioplasty is set to make another leap forward with further expansion of the indications and improved outcomes. Approximately two thirds of patients who require revascularisation have multi-vessel disease and two thirds of these have anatomy that is amenable to treatment by percutaneous or open heart procedures. 1 Both techniques have been shown to be relatively safe and highly effective in relieving angina, and have similar mortality and myocardial infarction rates; however, all the major studies have shown fewer additional revascularisation procedures in patients who undergo open heart surgery. 1 It is widely anticipated that the gap in repeat procedures may begin to close with the advent of drug eluting stents.