This Perspective article is a form of ‘pastiche’, inspired by the 1993 review by Lincoff and Topol entitled ‘Illusion of reperfusion’, and explores how their concept continues to apply to percutaneous revascularization in patients with coronary artery disease and ischaemia. Just as Lincoff and Topol argued that reperfusion of acute myocardial infarction was facing unresolved obstacles that hampered clinical success in 1993, we propose that challenging issues are similarly jeopardizing the potential benefits of stent-based angioplasty today. By analysing the appropriateness and efficacy of percutaneous coronary intervention (PCI), we emphasize the limitations of relying solely on visual angiographic guidance, which frequently leads to inappropriate stenting and overtreatment in up to one-third of patients and the associated increased risk of periprocedural myocardial infarction. The lack of optimal revascularization observed in half of patients undergoing PCI confers risks such as suboptimal physiology after PCI, residual angina and long-term stent-related events, leaving an estimated 76% of patients with an ‘illusion of revascularization’. These outcomes highlight the need to refine our diagnostic tools by integrating physiological assessments with targeted intracoronary imaging and emerging strategies, such as co-registration systems and angiography-based computational methods enhanced by artificial intelligence, to achieve optimal revascularization outcomes.

这篇《Perspective》文章是一种“仿制品”，其灵感来自于 1993 年 Lincoff 和 Topol 题为“再灌注错觉”的评论，探讨了他们的概念如何继续应用于冠状动脉疾病和缺血患者的经皮血运重建。正如 Lincoff 和 Topol 在 1993 年认为急性心肌梗死的再灌注面临着阻碍临床成功的未解决的障碍一样，我们认为，具有挑战性的问题同样危及当今基于支架的血管成形术的潜在益处。通过分析经皮冠状动脉介入治疗 (PCI) 的适当性和有效性，我们强调了仅依靠视觉血管造影指导的局限性，这经常导致多达三分之一的患者出现不适当的支架置入和过度治疗，以及相关的围手术期心肌梗死风险增加梗塞。在接受 PCI 的患者中，有一半观察到缺乏最佳血运重建，这带来了一些风险，例如 PCI 后生理机能欠佳、残余心绞痛和长期支架相关事件，使估计 76% 的患者产生“血运重建的错觉”。这些结果凸显了需要通过将生理评估与有针对性的冠状动脉内成像和新兴策略（例如人工智能增强的联合配准系统和基于血管造影的计算方法）相结合来完善我们的诊断工具，以实现最佳的血运重建结果。