Группа авторов

Interventional Cardiology


Скачать книгу

Trial Investigators. Strategies for multivessel revascularization in patients with diabetes.N Engl J Med 2012; 367: 2375.

      48 48 Mohr FW, Morice MC, Kappetein AP, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three‐vessel disease and left main coronary disease: 5‐year follow‐up of the randomised, clinical SYNTAX trial. Lancet 2013; 381: 629–638.

      49 49 Thuijs DJFM, Kappetein AP, Serruys PW et al. Percutaneous coronary intervention versus coronary artery bypass grafting in patients with three‐vessel or left main coronary artery disease: 10‐year follow‐up of the multicenter randomised controlled SYNTAX trial. Lancet 2019; 394:1325–1334.

      50 50 VA Coronary Artery Bypass Surgery Cooperative Study Group. Eighteen‐year follow‐up in the Veterans Affairs Cooperative Study of Coronary Artery Bypass Surgery for stable angina. Circulation 1992; 86: 121–130.

      51 51 Varnauskas E. Twelve‐year follow‐up of survival in the randomized European Coronary Surgery Study. N Engl J Med 1988; 319: 332–337.

      52 52 Passamani E, Davis KB, Gillespie MJ, Killip T. A randomized trial of coronary artery bypass surgery. Survival of patients with a low ejection fraction. N Engl J Med 1985; 312: 1665–1671.

      53 53 Yusuf S, Zucker D, Peduzzi P, et al. Effect of coronary artery bypass graft surgery on survival: overview of 10‐year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration. Lancet 1994; 344: 563–570.

      54 54 Myers WO, Schaff HV, Gersh BJ, et al. Improved survival of surgically treated patients with triple vessel coronary artery disease and severe angina pectoris: a report from the Coronary Artery Surgery Study (CASS) registry. J Thorac Cardiovasc Surg 1989; 97: 487–495.

      55 55 Velazquez EJ, Lee K, Deja MA, et al. Coronary‐artery bypass surgery in patients with left ventricular dysfunction. N Engl J Med 2011; 364:1607–1616.

      56 56 Velazquez EJ, Lee K, Jones RH et al. Coronary‐artery bypass surgery in patients with ischemic cardiomyopathy. N Engl J Med 2016; 374:1511–1520.

      57 57 Hannan EL, Racz MJ, Walford G, et al. Long‐term outcomes of coronary‐artery bypass grafting versus stent implantation. N Engl J Med 2005; 352: 2174–2183.

      CHAPTER 12

      PCI Strategies in Acute Coronary Syndromes without ST Segment Elevation (NSTE‐ACS)

       Anastasios Roumeliotis and Emmanouil S. Brilakis

      Acute coronary syndromes (ACS) include both ST elevation myocardial infarction (STEMI) and non‐ST‐ elevation ACS (NSTE‐ACS). NSTE‐ACS are is subdivided in non‐ST‐elevation myocardial infarction (NSTEMI) and unstable angina (UA). Pathophysiologically, STEMI correlates with vessel occlusion, NSTEMI with critical vessel stenosis and UA with vulnerable atheromatous plaque, partially obstructing the coronary lumen [1]. While emergent myocardial revascularization has been well established in STEMI, it is not needed in NSTE‐ACS except for unstable patients. This chapter reviews risk stratification, emergency department (ED) diagnosis, revascularization strategies and adjunctive pharmacologic therapies for patients presenting with NSTE‐ACS.

Schematic illustration of advantages and disadvantages or high sensitivity cardiac troponin.

      AMI, acute myocardial infarction; CKD, chronic kidney disease; ED, emergency department.

GRACE score TIMI score
Variables Prognosis(6‐month death/MI) Variables Prognosis(14‐day MACE*)
AgeHeart rateSystolic BPCreatinineCHFCardiac arrest on admissionST‐segment deviationElevated cardiac enzymes 0‐85 → 0‐2%86‐153 → 3‐10%154‐190 → 11‐20%191‐204 → 21‐25%205‐235 → 26‐30%236‐255 → 40%>255 → 50% Age ≥653 or more CAD risk factors**Preexisting CAD (≥50% stenosis)Aspirin use in the past 7 daysSevere angina (≥2 episodes in 24 hours)EKG ST changes ≥0.5mmPositive cardiac biomarkers 10/1 → 4.7%1121→ 8.3%1113 → 13.2%1114 → 19.9%1115 → 26.2%16/7 → 40.9%

      BP, blood pressure; CHF, congestive heart failure; CAD, coronary artery disease; EKG, electrocardiogram; MI, myocardial infarction; MACE, major adverse cardiac events. * MACE is a composite of all‐cause mortality, recurrent MI, or severe recurrent ischemia requiring urgent revascularization. ** Hypertension, hypercholesterolemia, diabetes, family history of CAD, or current smoker.

      When evaluating patients with definite or likely NSTE‐ACS, an early invasive strategy should be weighed against an ischemia‐guided strategy [7]. A more