医学
心源性休克
传统PCI
血运重建
心脏病学
经皮冠状动脉介入治疗
心肌梗塞
内科学
罪魁祸首
冠状动脉疾病
出处
期刊:Current Opinion in Critical Care
[Ovid Technologies (Wolters Kluwer)]
日期:2019-08-01
卷期号:25 (4): 379-383
被引量:6
标识
DOI:10.1097/mcc.0000000000000623
摘要
Purpose of review Coronary revascularization compared with medical treatment alone leads to improved survival in patients with myocardial infarction (MI) and cardiogenic shock. Percutaneous coronary intervention (PCI) is the predominant mode of revascularization in clinical practice. This review discusses several aspects relevant to mechanical revascularization such as general indication, the roles of PCI and bypass surgery, percutaneous access site choice, strategy in multivessel disease and adjunctive antithrombotic therapy. Recent findings The recently published CULPRIT-SHOCK trial provided the first randomized evidence that in the vast majority of patients with infarct-related cardiogenic shock PCI should be confined to the culprit lesion, whereas nonculprit lesions should not be routinely treated in the emergency setting. Although randomized data are not available, a primary radial access for PCI is becoming more popular in the shock population. Cardiac surgery plays an indispensable, yet quantitatively only minor role in the management of infarct-related cardiogenic shock. Summary Coronary revascularization remains the cornerstone in the early management of patients with acute MI and cardiogenic shock. In patients with multivessel disease, a strategy of culprit lesion only PCI is the default approach.
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