冠状动脉多支病变急诊介入治疗策略进展

摘要

急诊冠状动脉介入术(PPCI)及时开通梗死相关血管是目前处理急性ST段抬高型心肌梗死最佳的再灌注策略.而大约50%的ST段抬高型心肌梗死患者存在多支血管病变,2011年ACC/AHA关于PPCI的指南,以及2013年ACC/AHA关于ST段抬高型心肌梗死的指南中PPCI部分均不推荐(Ⅲ类推荐)对血流动力学稳定的患者在PPCI中同时处理非梗死相关血管.2014年ESC指南和2015年ACC/AHA已将PPCI中同时处理非梗死相关血管由Ⅲ类推荐(不推荐)调整为Ⅱb类推荐.现对冠状动脉多支病变急诊治疗策略进展进行综述.%Primary percutaneous coronary intervention(PPCI)is the best treatment strategy for ST-segment elevation myocardial in-farction(STEMI).About 50%of patients with STEMI have multivessel disease and 2011 ACC/AHA guidelines on PPCI,and the PPCI sec-tion of the ACC/AHA guidance on STEMI in 2013,are not recommended(ClassⅢrecommendations)for patients with hemodynamic stabili-ty at the same time in the treatment of non-infarct-related artery in PPCI.However,the 2014 ESC guidelines and the ACC/AHA in 2015 have recommended that PPCI is simultaneously treated with non-infarct-related artery from class Ⅲrecommendations(not recommended)to classⅡB.The article describes the progress of emergency treatment strategy for coronary multivessel disease.