PDF(Pubmed)
Abstract：
Chronic total occlusions (CTOs) of coronary arteries can be found in the context of chronic or acute coronary syndromes; sometimes they are an incidental finding in those apparently healthy individuals undergoing imaging for preoperative risk assessment. Recently, the invasive management of CTOs has made impressive progress due to sophisticated preinterventional assessment, including advanced non-invasive imaging, the availability of novel and dedicated tools for CTO percutaneous coronary intervention (PCI), and experienced interventionalists working in specialised centres. Thus, it is crucial that referring physicians who see patients with CTO be aware of recent developments and of the initial evaluation requirements for such patients. Besides a careful history and clinical examination, electrocardiograms, exercise tests, and non-invasive imaging modalities are important for selecting the patients most suitable for CTO PCI, while others may be referred to coronary artery bypass graft or optimal medical therapy only. While CTO PCI improves angina and reduces the use of antianginal drugs in patients with symptoms and proven ischaemia, hibernation and/or wall motion abnormalities at baseline or during stress, the effect of CTO PCI on major cardiovascular events is still controversial. This clinical consensus statement specifically focuses on referring physicians, providing a comprehensive algorithm for the preinterventional evaluation of patients with CTO and the current evidence for the clinical effectiveness of the procedure. The proposed care track has been developed by members and with the support of the European Association of Percutaneous Cardiovascular Interventions (EAPCI), the European Association of Cardiovascular Imaging (EACVI), and the European Society of Cardiology (ESC) Working Group on Cardiovascular Surgery.
摘要：
在慢性或急性冠状动脉综合征的背景下可以发现冠状动脉的慢性完全闭塞（CTO）；有时它们是在接受术前风险评估成像的明显健康个体中的偶然发现。最近,由于复杂的介入前评估，CTO的侵入性管理取得了令人印象深刻的进展，包括先进的非侵入性成像，CTO经皮冠状动脉介入治疗（PCI）的新型专用工具的可用性，和在专业中心工作的经验丰富的干预主义者。因此，至关重要的是,就诊CTO患者的转诊医师要了解此类患者的最新进展和初步评估要求.除了仔细的病史和临床检查，心电图,运动测试,非侵入性成像模式对于选择最适合CTOPCI的患者很重要，而其他患者可能仅参考冠状动脉旁路移植术或最佳药物治疗。虽然CTOPCI改善了心绞痛并减少了有症状和已证实的缺血患者的抗心绞痛药物的使用，基线或压力期间的冬眠和/或壁运动异常，CTOPCI对主要心血管事件的影响仍存在争议.这一临床共识声明特别侧重于转诊医生，为CTO患者的介入前评估提供了全面的算法，并为该程序的临床有效性提供了当前的证据。在欧洲经皮心血管介入协会（EAPCI）的支持下，成员制定了拟议的护理轨道，欧洲心血管成像协会（EACVI），和欧洲心脏病学会（ESC）心血管外科工作组。
