Yang Eric H, Barsness Gregory W, Gersh Bernard J, Chandrasekaran Krishnaswamy, Lerman Amir
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA.
Mayo Clin Proc. 2004 Oct;79(10):1284-92. doi: 10.4065/79.10.1284.
Patients with refractory angina are not candidates for revascularization and have both class III or IV angina and objective evidence of ischemia despite optimal medical therapy. An estimated 300,000 to 900,000 patients in the United States have refractory angina, and 25,000 to 75,000 new cases are diagnosed each year. This review focuses on treatment strategies for refractory angina and includes the mechanism of action and clinical trial data for each strategy. The pharmacological agents that have been used are ranolazine, ivabradine, nicorandil, L-arginine, testosterone, and estrogen; currently, only L-arginine, testosterone, and estrogen are approved by the Food and Drug Administration. Results with the noninvasive treatments of enhanced external counterpulsation and transcutaneous electrical nerve stimulation are provided. Invasive treatment strategies including spinal cord stimulation, transmyocardial revascularization, percutaneous myocardial revascularization, and gene therapy are also reviewed.
难治性心绞痛患者不适合进行血运重建,尽管接受了最佳药物治疗,但仍有Ⅲ级或Ⅳ级心绞痛且有缺血的客观证据。据估计,美国有30万至90万患者患有难治性心绞痛,每年有2.5万至7.5万新病例被诊断出来。本综述重点关注难治性心绞痛的治疗策略,包括每种策略的作用机制和临床试验数据。已使用的药物有雷诺嗪、伊伐布雷定、尼可地尔、L-精氨酸、睾酮和雌激素;目前,只有L-精氨酸、睾酮和雌激素获得了美国食品药品监督管理局的批准。还提供了增强型体外反搏和经皮电神经刺激等非侵入性治疗的结果。包括脊髓刺激、经心肌血运重建、经皮心肌血运重建和基因治疗在内的侵入性治疗策略也在综述中进行了讨论。