Surgical Turned-Downed CHIP Cases-Can PCI Save the Day?
Surgical Turned-Downed CHIP Cases-Can PCI Save the Day?
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DOI：
10.3389/fcvm.2022.872398
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发表时间：
2022
影响因子：
3.6
通讯作者：
中科院分区：
文献类型：
--
作者：
目前的指导方针，很少，如果根本，解决决策的血运重建术时，不可能搭桥手术的高危病例。被手术拒绝的患者通常被排除在临床试验之外，即使他们仍然有症状。此外，在标准化的风险模型中往往没有捕捉到手术不合格的原因。没有关于这些患者PCI手术后健康状况结果的数据，最终的问题仍然是在这个有争议的亚群中PCI的益处是否大于其风险。当为这些非常复杂的个体选择CHIP（复杂高风险指经皮冠状动脉介入治疗）时，对于介入血运重建术的目标（例如，实现血运重建术的目标与更有针对性或选择性的PCI相比）没有一致意见。认识到，在世界范围内，这些患者在心导管实验室中变得越来越普遍，越来越普遍，以及更复杂的介入程序和扩展技能的势头，给了我们一个及时的机会，更好地检查这些患者的结果，并为临床决策提供信息。
Current guidelines, rarely if at all, address decision-making for revascularization when bypass surgery is not a possibility for high-risk cases. Patients who are surgically turned down are routinely excluded from clinical trials, even though they remain symptomatic. Furthermore, the reasons for surgical ineligibility are often times not captured in standardized risk models. There is no data regarding health status outcomes following PCI procedures in these patients and the ultimate question remains whether the benefits of PCI outweigh its risks in this controversial subpopulation. When CHIP (Complex High risk Indicated Percutaneous coronary interventions) is selected for these very complex individuals, there is no unanimity regarding the goals for interventional revascularization (for instance, the ambition to achieve completeness of revascularization vs. more targeted or selective PCI). The recognition that, worldwide, these patients are becoming increasingly prevalent and increasingly commonplace in the cardiac catheterization labs, along with the momentum for more complex interventional procedures and expanding skillsets, gives us a timely opportunity to better examine the outcomes for these patients and inform clinical decision-making.
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