在冠状动脉疾病的侵袭性与保守管理
Shereif H Rezkalla1, Robert A Kloner2
1Department of Cardiology, Marshfield Clinic Health System, Marshfield, Wisconsin; Adjunct Professor of Medicine, University of Wisconsin, School of Medicine, Madison, Wisconsin rezkalla.shereif@marshfieldclinic.org.
Clinical medicine & research
|July 5, 2023
概括
为所有冠状动脉疾病患者推最佳的医疗治疗. 早期的侵入性策略最适合那些患有左心室功能障碍,心力衰竭或耐治疗症状的人,优先考虑共享决策.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
背景情况:
- ST升高心肌梗塞 (STEMI) 管理有利于立即血管造影和干预.
- 非Q波心脏病指南建议早期的侵入性策略,而不是保守的管理.
- 在心肌梗塞中,完整的复血管化是首选的方法.
研究的目的:
- 审查冠状动脉疾病 (CAD) 的管理策略.
- 在不同的CAD演示中评估侵入性与保守性方法的作用.
- 突出最佳医疗治疗和风险因素修改的重要性.
主要方法:
- 在PubMed的文献搜索 (1985-2021) 进行冠状动脉疾病管理.
- 包括英语文章,重点是ISCHEMIA试验.
- 两位作者对相关研究进行了审查和选择.
主要成果:
- 最佳的医疗治疗是所有稳定的冠状动脉疾病患者的基础.
- 对于稳定的CAD,非侵入性成像,如冠状动脉计算机断层扫描血管造影 (CCTA) 优先于侵入性血管造影.
- 建议对患有左主病,左心室功能障碍或充血性心力衰竭的患者采取早期入侵策略.
- 医疗治疗和风险因素修改是慢性稳定性 angina 的关键;如果症状恶化,则考虑进行血管造影.
- 功能障碍的血管造影仅用于医学治疗完全失败的病例.
结论:
- 对所有患者来说,最佳的药物治疗应该是最初的方法.
- 对于特定的高风险群体,早期的侵入性治疗和再血管化是适合的.
- 在指导冠状动脉疾病的治疗策略方面,共享决策至关重要.
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