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EuroPCR重新定义慢性冠状动脉综合征:生理影像学指导的介入治疗走上前台

2018-05-23 文韬 中国循环杂志

大家都知道急性冠状动脉综合征,而在近期召开的EuroPCR2018上,慢性冠状动脉综合征(CCS)成了热门话题。

大家都知道急性冠状动脉综合征,而在近期召开的EuroPCR2018上,慢性冠状动脉综合征(CCS)成了热门话题。

心绞痛是慢性冠状动脉综合征的一个重要症状。此外,慢性冠状动脉综合征还影响生活质量(QoL),降低耐力,有精神症状、急症冠脉综合征复发住院等。

德国诺伊斯医学院Lukas医院Michael Haude在会上发布了发布了“稳定性冠心病经皮冠状动脉介入(PCI)治疗决策的PCR声明”。

他表示,“之前,冠脉介入治疗(PCI)对慢性冠脉综合征患者一直受到质疑。现代药物洗脱支架技术和近期的影像学技术可进一步识别缺血病变,有助于改善结果。在EuroPCR 2018期间发布了几个新研究强烈支持PCI在慢性冠脉综合征治疗中的积极作用。”

最新数据:

ORBITA研究的生理学分层分析结果证明PCI可改善缺血,如多巴酚丁胺负荷超声心动图评估的结果,并使更多患者无心绞痛。FFR和iFR可以预测PCI对局部缺血的作用强度,但这只能仅见于负荷超声中,症状评分或运动时间中未见。研究同时发表在Circulation上。

GZ-FFR研究两个月后的结果显示,PCI可显着降低心绞痛发作频率,生活质量得到改善,超过了ORBITA研究,但该研究非盲。

FAME2、DANAMI-3-PRIMULTI和COMPARE-ACUTE的汇总分析显示,FFR指导的PCI与单纯的药物治疗相比,硬终点改善。在稳定性冠脉病变的患者中,无论症状改善与否,FFR指导的PCI降低了未来心肌梗死或心源性死亡的风险。

来自瑞典冠状动脉造影和血管成形术登记(SCAAR)的报告,随访10年后,FFR/iFR指导PCI组的总死亡率\再狭窄率和支架血栓形成率明显降低。

声明要点包括:

1、最近的数据提供了一个强有力的信号,FFR / iFR,生理影像学指导的PCI在死亡率,再狭窄和支架血栓方面优于冠状动脉造影指导的PCI。

2、与单独的药物治疗相比,PCI导致心绞痛减少,生活质量更好,紧急血运重建更少,自发性心肌梗死更少。

3、PCI后的观察时间越长,PCI所带来的好处就越大。

4、对于特定冠状动脉病变记录的缺血程度越大,PCI所表现出的益处越大。

原始出处:

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    2018-05-25 Tommy1950
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    2018-05-23 1201e5c5m39暂无昵称

    学习了

    0

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    2018-05-23 wzb521zf

    一起学习学习

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    2018-05-23 哈哈869

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