Bhatt Ami B, Stone Peter H
Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Curr Opin Cardiol. 2006 Sep;21(5):492-502. doi: 10.1097/01.hco.0000240588.22086.43.
Angina pectoris affects at least 6.6 million people in the US and approximately 400,000 new cases of stable angina occur each year. Angina may be one of the first signs of ischemic heart disease, although it is likely not causally related to the likelihood of plaque rupture leading to an acute coronary syndrome. Modalities for treatment of angina should be used maximally to improve quality of life and decrease cardiovascular morbidity and mortality. The current recommended pharmacologic and invasive approaches, as well as novel therapies, are reviewed.
Antiischemic agents, including beta-blockers, nitrates and calcium channel blockers, remain the mainstay in the prevention of angina. Revascularization via percutaneous interventions or coronary bypass surgery are appropriate in specific cases or when medical treatment fails. Noninvasive treatment options for refractory angina, metabolic agents, and vasodilator therapies are adding to the armamentarium to prevent and treat angina.
A multifaceted approach is optimal to address the prevention of angina. Once angina is recognized, there are many modalities that lessen the incidence of daily life-induced and exercise-induced angina and ischemia. Angina management is best addressed by pharmacologic and lifestyle interventions.
在美国，心绞痛影响着至少660万人，每年约有40万例稳定型心绞痛新发病例。心绞痛可能是缺血性心脏病的首发症状之一，尽管它可能与斑块破裂导致急性冠状动脉综合征的可能性没有因果关系。应最大限度地采用心绞痛治疗方法，以提高生活质量，降低心血管疾病的发病率和死亡率。本文对目前推荐的药物治疗和侵入性治疗方法以及新疗法进行综述。
抗缺血药物，包括β受体阻滞剂、硝酸盐和钙通道阻滞剂，仍然是预防心绞痛的主要药物。在特定情况下或药物治疗无效时，通过经皮介入治疗或冠状动脉搭桥手术进行血运重建是合适的。难治性心绞痛的非侵入性治疗选择、代谢药物和血管扩张剂疗法正在增加预防和治疗心绞痛的手段。
多方面的方法是预防心绞痛的最佳选择。一旦确诊心绞痛，有多种方法可以减少日常生活诱发和运动诱发的心绞痛及缺血的发生率。心绞痛的管理最好通过药物治疗和生活方式干预来解决。
