冠脉血运重建在高危复杂冠心病患者治疗中的应用现状

Current status of coronary revascularization in the treatment of complex high-risk and indicated patients

高危复杂冠心病患者(complex high-risk and indicated patients,CHIPs)是指一类具有严重冠心病需要进行血运重建且手术风险极高的患者。目前关于CHIPs的治疗策略主要有优化药物治疗、血运重建以及机械循环支持(mechanical circulatory support,MCS)。对于CHIPs而言,药物治疗难以使患者显著获益;以经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)与冠状动脉搭桥术(coronary artery bypass graft,CABG)为主要手段的血运重建治疗可部分或完全实现患者的冠脉血运重建,改善患者心脏功能,提高生存质量,但需要在遵循目前基本共识的基础上高度个体化选择。MCS在冠脉血运重建治疗中的作用各有优劣,亦需合理选择使用。此外,CHIPs的多学科治疗团队在CHIPs的治疗与管理中至关重要。本文重点围绕CHIPs的临床治疗选择及相关问题进行综述。

Complex high-risk and indicated patients(CHIPs)are a group of patients with severe coronary artery disease who require revascularization and are at high risk for surgery.Current treatment strategies for CHIPs include optimal medical therapy,revascularization,and mechanical circulatory support(MCS).For CHIPs,optimal medical therapy is difficult to benefit patients significantly;percutaneous coronary intervention(PCI)and coronary artery bypass graft(CABG)as the main means can partially or completely achieve coronary revascularization,improve patients’cardiac function and enhance the quality of survival,but requires highly individualized selection based on the current basic consensus.The role of MCS in coronary revascularization therapy has its advantages and disadvantages and needs to be appropriately selected for use.In addition,a multidisciplinary treatment team for CHIPs is essential in the treatment and management of CHIPs.This paper focuses on a review of clinical treatment options and related issues for CHIPs.