重血管化的幻觉:有人在穿皮冠状动脉干预期间实现最佳的重血管化吗?
Simone Fezzi1,2, Daixin Ding1,3, Felix Mahfoud4,5,6
1The Lambe Institute for Translational Medicine, the Smart Sensors Laboratory and Curam, University of Galway, Galway, Ireland.
Nature reviews. Cardiology
|May 6, 2024
概括
由于当前指导方针的局限性,许多接受皮肤穿透冠状动脉干预 (PCI) 的患者经历了"再血管化的幻觉". 整合生理评估和先进成像对于冠状动脉疾病的最佳结果至关重要.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 医疗成像医学成像
背景情况:
- 1993年",再输液错觉"的概念突出了急性心肌梗塞治疗中的障碍.
- 冠状动脉疾病的皮肤再血管化今天面临着类似的挑战,可能会限制基于支架的血管造形术的好处.
研究的目的:
- 分析穿皮冠状动脉干预 (PCI) 的适当性和有效性.
- 强调在PCI中仅依赖血管学指导的局限性.
- 突出需要改进的诊断工具,以实现最佳的再血管化.
主要方法:
- 展望审查分析PCI适当性和结果的现有数据.
- 讨论视觉血管学指导的局限性.
- 探索新兴的诊断和成像策略.
主要成果:
- 视觉血管学指导导致不适当的支架和过度治疗,高达三分之一的患者.
- 与当前的PCI实践相关的周围手术心肌梗塞风险增加.
- 在接受PCI的患者中,有一半的患者表现出不理想的生理学,残留性心痛或长期支架相关事件,导致76%的病例出现"再血管化的幻觉".
结论:
- 目前的PCI实践,严重依赖于血管造影,导致显著比例的患者出现低于最佳的再血管化.
- 有必要整合生理评估,冠心内成像和人工智能增强的计算方法.
- 精细的诊断方法对于实现真正的最佳再血管化和改善冠状动脉疾病患者的治疗结果至关重要.
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