非ST段抬高型急性冠脉综合征合并多支血管病变处理方式的研究进展

Progress of the treatment of non-ST-elevation acute coronary syndrome with multi-vessel disease

经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)具有创伤小、手术成功率高、并发症少等优点,其对急性非ST段抬高型急性冠脉综合征(non-ST-elevation acute coronary syndrome,NSTE-ACS)合并多支血管病变的诊断及治疗已经获得充分肯定。但就其处理方式,罪犯血管开通后非罪犯血管是否需要处理,临床研究结果并不一致:仅处理罪犯血管(culprit-only revascularization,COR),还是一次性完全血运重建(one-time complete revascularization,CR)?以及非罪犯血管的处理时机,择期处理非罪犯血管(staged revascularization,SR),还是CR?专家意见存在分歧。本文就罪犯血管开通后非罪犯血管是否需要处理,以及非罪犯血管处理时机的现状进行综述,为临床进一步治疗提供思路。

Currently,percutaneous coronary intervention（PCI）has many advantages,for example surgical trauma,high success rate of operation and fewer complications.So,patients with non-ST-elevation acute coronary syndrome（NSTE-ACS）with multi-vessel disease（MVD）are amenable to PCI.However,in terms of its treatment,there is a question of whether the procedure should be performed immediately after culprit vessel revascularization or it should be postponed until the patient is stabilized.There are several methods to be chose.They were categorized into culprit-only revascularization,staged revascularization and one-time complete revascularization according to intervention strategy.The clinical findings are inconsistent.This article reviews the current situation in this field,and provides ideas for further treatment.