Department of Cardiology, Portsmouth Hospitals NHS Trust, St Mary's Hospital, Milton Road, Portsmouth PO3 6AD, UK.
QJM. 2010 May;103(5):305-10. doi: 10.1093/qjmed/hcq011. Epub 2010 Feb 24.
In the management of chronic stable angina, percutaneous coronary intervention (PCI) provides symptomatic relief of angina rather than improvement of prognosis. Current guidelines recommend optimization of medical therapy prior to elective PCI. It is not clear if these guidelines are adhered to in clinical practice.
The aim of this multi-centre study was to determine the extent to which these treatment guidelines are being implemented in the UK.
This was a multi-centre study involving six hospitals in the UK.
The medical treatment and extent of risk factor modification was recorded for consecutive patients undergoing elective PCI for chronic stable angina at each site. Data collected included anti-anginal drug therapy, lipid levels and blood pressure (BP). Data on heart rate (HR) control were also collected, since this represents a fundamental part of medical anti-anginal therapy. Target HR is <60 b.p.m. for symptomatic angina.
A total of 500 patients [74% male; mean age +/- SD (64.4 +/- 10.1 years)] were included. When considering secondary prevention, 85% were receiving a statin and 76% were on an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. In terms of medical anti-ischaemic therapy, 78% were receiving beta-blockers [mean equivalent dose of bisoprolol 3.1 mg (range 1.25-20 mg)], 11% a rate limiting calcium antagonist, 35% a nitrate or nicorandil and one patient was receiving ivabradine. The mean total cholesterol (95% confidence interval) was 4.3 mmol/l (4.2-4.4), mean systolic BP of 130 +/- 24 mmHg and mean diastolic BP of 69 +/- 13 mmHg. Serum cholesterol was <5 mmol/l in 77% and <4 mmol/l in 42% of the patients, 62% of the patients had systolic BP < 140 mmHg and 92% had diastolic BP < 90 mmHg. Considering European Society of Cardiology targets, 50% had systolic BP < 130 mmHg and 76% had diastolic BP < 80 mmHg. A large proportion of patients did not achieve target resting HR; 27% of patients had a resting HR of >or=70 b.p.m., 40% had a resting HR between 60 and 69 b.p.m. and 26% had a resting HR between 50 and 59 b.p.m. The resting HR was not related to the dose of beta-blocker.
A significant proportion of the patients with chronic stable angina undergoing elective PCI did not achieve therapeutic targets for lipid, BP and HR control. Over 50% of patients did not receive adequate HR lowering anti-anginal therapy to achieve recommended target resting HR.
在慢性稳定型心绞痛的治疗中，经皮冠状动脉介入治疗（PCI）可以缓解心绞痛症状，但并不能改善预后。目前的指南建议在选择性 PCI 前优化药物治疗。目前尚不清楚这些指南在临床实践中是否得到了遵守。
本多中心研究的目的是确定这些治疗指南在英国的实施程度。
这是一项多中心研究，涉及英国的 6 家医院。
在每个地点，连续接受择期 PCI 治疗慢性稳定型心绞痛的患者记录药物治疗和危险因素修正的程度。收集的数据包括抗心绞痛药物治疗、血脂水平和血压（BP）。还收集了心率（HR）控制的数据，因为这是药物抗心绞痛治疗的一个基本部分。目标 HR 为有症状的心绞痛<60 b.p.m.。
共纳入 500 例患者[74%为男性；平均年龄 +/- 标准差（64.4 +/- 10.1 岁）]。考虑到二级预防，85%的患者接受他汀类药物治疗，76%的患者接受血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂治疗。在医学抗缺血治疗方面，78%的患者接受β受体阻滞剂[等效剂量比索洛尔 3.1mg（范围 1.25-20mg）]，11%的患者接受钙通道阻滞剂，35%的患者接受硝酸盐或尼克地尔，1 例患者接受伊伐布雷定。总胆固醇（95%置信区间）的平均值为 4.3mmol/l（4.2-4.4），平均收缩压为 130 +/- 24mmHg，平均舒张压为 69 +/- 13mmHg。77%的患者血清胆固醇<5mmol/l，42%的患者血清胆固醇<4mmol/l，62%的患者收缩压<140mmHg，92%的患者舒张压<90mmHg。考虑到欧洲心脏病学会的目标，50%的患者收缩压<130mmHg，76%的患者舒张压<80mmHg。很大一部分患者未达到目标静息 HR；27%的患者静息 HR≥70 b.p.m.，40%的患者静息 HR 在 60-69 b.p.m.之间，26%的患者静息 HR 在 50-59 b.p.m.之间。静息 HR 与β受体阻滞剂的剂量无关。
接受择期 PCI 的慢性稳定型心绞痛患者中，有相当一部分患者未达到血脂、血压和 HR 控制的治疗目标。超过 50%的患者未接受足够的 HR 降低抗心绞痛治疗以达到推荐的静息 HR 目标。
