长效钙拮抗剂的广泛使用是否降低了变异型心绞痛的发生率？

Did the widespread use of long-acting calcium antagonists decrease the occurrence of variant angina?

作者信息

Sueda Shozo, Kohno Hiroaki, Fukuda Hiroshi, Uraoka Tadao

机构信息

Department of Cardiology, Saiseikai Saijo Hospital, Tsuitachi 269-1, Saijo City, Ehime Prefecture, Japan 793-0027.

出版信息

Chest. 2003 Dec;124(6):2074-8. doi: 10.1378/chest.124.6.2074.

DOI:10.1378/chest.124.6.2074

PMID:14665482

Abstract

BACKGROUND

We have not often encountered variant angina (VA) since the use of long-acting calcium antagonists (L-CAs) became widespread.

OBJECTIVES

This study examined the frequency of VA retrospectively.

METHODS

and results: We diagnosed angiographically confirmed coronary spastic angina (CSA) in 349 consecutive patients using selective spasm provocation tests from January 1991 to December 2002. During this period, 3,148 diagnostic cardiac catheterizations and 1,515 selective spasm provocation tests were performed. Seventy-four of these 349 patients (21.2%) had VA. Coronary spasms were defined as transient luminal narrowings of > 99%, and VA was defined as an ST elevation during spontaneous attacks or noninvasive stress tests. We classified the 12 years of the study into four periods of 3 years each. No tendency to decrease for the ratio of the number of patients with CSA and the number of selective spasm provocation tests was observed among the four time periods (18%, 24%, 32%, and 23%, respectively). However, the number of patients with VA (28, 33, 9, and 4) and the VA/CSA ratio (32%, 28%, 14%, and 5%, respectively) in the four group significantly decreased. The frequency of administration of calcium antagonists (CAs) before hospital admission (49% vs 33%, respectively; p < 0.05) was significantly higher in the last time period (from 2000 to 2002) than in the first period (from 1991 to 1993). L-CAs were administered in > 90% of CSA patients who had been medicated with CAs before hospital admission in the last period (from 2000 to 2002), while L-CAs were administered in only 20% in the former period (from 1991 to 1993). The administration of statins and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers before hospital admission gradually increased according to the period passed, but not significantly.

CONCLUSION

The frequency of VA has decreased in Japan, possibly due to the widespread use of therapy with L-CAs.

摘要

背景

自从长效钙拮抗剂（L-CAs）广泛应用以来，我们很少遇到变异型心绞痛（VA）。

目的

本研究回顾性调查VA的发生频率。

方法与结果

1991年1月至2002年12月期间，我们对349例连续患者进行选择性痉挛激发试验，通过血管造影确诊为冠状动脉痉挛性心绞痛（CSA）。在此期间，共进行了3148例诊断性心脏导管插入术和1515例选择性痉挛激发试验。这349例患者中，74例（21.2%）患有VA。冠状动脉痉挛定义为管腔短暂狭窄>99%，VA定义为自发发作或无创应激试验期间ST段抬高。我们将研究的12年分为4个3年期。在这4个时间段中，未观察到CSA患者数量与选择性痉挛激发试验数量之比有下降趋势（分别为18%、24%、32%和23%）。然而，4组中VA患者数量（分别为28、33、9和4例）及VA/CSA比值（分别为32%、28%、14%和5%）显著下降。最后一个时间段（2000年至2002年）入院前钙拮抗剂（CAs）的使用频率（分别为49%对33%；p<0.05）显著高于第一个时间段（1991年至1993年）。在最后一个时间段（2000年至2002年）入院前接受CAs治疗的CSA患者中，超过90%使用了L-CAs，而在前一个时间段（1991年至1993年）仅为20%。入院前他汀类药物和血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂的使用随时间逐渐增加，但无显著差异。