正确认识ACC/AHA/SCAI冠状动脉心肌血运重建指南2021版中对冠状动脉旁路移植术和桡动脉相关推荐的变化

Accurate understanding of the changes in the recommendations on coronary artery bypass grafting and radial artery in the 2021 ACC/AHA/SCAI Guideline For Coronary Artery Revascularization

美国心脏病学院、美国心脏协会、美国心血管和介入学会在冠状动脉心肌血运重建指南2021版中, 将冠状动脉旁路移植术(CABG)治疗冠心病三支病变从原先的Ⅰ类推荐降为Ⅱb类推荐, 并将桡动脉作为旁路材料从原先的Ⅱa类推荐提升为Ⅰ类推荐, 上述变化受到各国心脏外科医师和多个心脏外科协会及学会的关注和质疑, 集中在作为证据的ISCHEMIA研究存在明显的选择偏倚, 未考虑CABG在合并高危因素的患者中的长期通畅率优势, 以及未强调桡动脉旁路有明确的适用人群。广泛收集、谨慎遴选证据, 与多学科团队中的心脏外科医师紧密合作, 才能形成更合理更全面的指南建议。

The 2021 ACC/AHA/SCAI Guideline For Coronary Artery Revascularization has been brought into focus and widely questioned by multiple associations of cardiac surgeons around the world,in which the class of recommendation(COR)for coronary artery bypass grafting(CABG)was downgraded fromⅠtoⅡb in the treatment of 3 vessel coronary artery disease,and the use of radial artery as CABG conduit was elevated to CORⅠ.The ISCHEMIA trial,which was cited by the guidelines as evidence,had obvious selection bias.It did not consider the advantages of long-term patency rate of CABG in patients with high risk factors,and did not define that radial artery bypass has a certain applicable population.Only by widely collecting and carefully selecting evidence and collaborating with cardiac surgeons in the multidisciplinary team of coronary heart disease,the more reasonable and comprehensive guidelines and suggestions could be formed.