急性冠状动脉综合征中非罪犯病变管理的研究进展

Research progress of management of non-culprit lesions in acute coronary syndrome

急性冠状动脉综合征发病率高且预后较差,及时行经皮冠状动脉介入治疗开通罪犯血管是目前救治的关键。术中可发现许多患者合并有多支血管病变,且部分非罪犯病变会快速进展导致不良事件的发生。因此对非罪犯病变的评估和适当干预成为目前研究的热点。相较于传统的冠状动脉造影,冠状动脉功能学检查及影像学技术为进一步评估病变的血流储备能力、斑块特点及是否需要血运重建等方面提供了有力帮助。近年来临床研究发现,完全血运重建相较于仅处理罪犯血管可以改善患者的临床结局。本文对如何管理非罪犯病变进行综述。

Acute coronary syndrome(ACS)has a high incidence and poor prognosis,and the timely opening of the culprit vessel with coronary intervention is now the key to salvage.Intraoperatively,many patients can be found to have a combination of multi-vessel lesions,and some non-culprit lesions can progress rapidly leading to adverse events.Compared with traditional coronary angiography,the functional coronary assessment and intracoronary imaging techniques provide a powerful tool to further assess the flow reserve capacity of lesions,plaque characteristics and the need for revascularization.In recent years,clinical studies have found that complete revascularization could improve the clinical outcomes of patients compared with only addressing the culprit vessel.This article therefore provides a review of how to manage non-culprit lesions.