Seabra-Gomes Ricardo
Instituto do Coração, Carnaxide.
Rev Port Cardiol. 2010 Apr;29(4):483-508.
To characterize a population with stable coronary artery disease (CAD) in an outpatient setting and to evaluate the importance of resting heart rate (HR), a recently recognized prognostic risk factor.
A prospective and observational registry of patients with stable CAD followed mainly by cardiologists in private outpatient clinics.
Patients were selected by at least one of the following inclusion criteria: coronary angiography with at least one significant stenosis; positive stress test; previous myocardial infarction; or revascularization by angioplasty or surgery. Demographics, concomitant diseases, HR, blood pressure (BP), presence of angina and medical therapy were all recorded. Data compilation and statistical analysis were performed by a CRO independent of the sponsor and the investigators.
Between May and October 2009, 3477 consecutive patients were included by 186 doctors. Mean age was 66.6 +/- 10.1 years and 26.3% were female, 76% had arterial hypertension, 34% diabetes, 47% previous infarction, 42% angioplasty and 25% coronary surgery. Of concomitant diseases, 13% of patients had peripheral vascular disease or erectile dysfunction. Medical therapy included antiplatelet agents (97%), lipid-lowering agents (92%), beta-blockers (72%), ACEIs (54%), nitrates (39%), calcium blockers (36%), ARBs (28%), ivabradine (24%) and trimetazidine (17%). Mean HR was 67 +/- 12 bpm and 67% of patients had HR > 60 bpm. Mean systolic BP was 134 +/- 18 mmHg and mean diastolic BP was 76 +/- 10 mmHg. Angina was present in 31.3% of patients and 53.4% had class II angina. The population with angina was more severe, 74% had HR > 60 bpm and 68% were taking beta-blockers. In patients with angina and HR > 60 bpm, beta-blocker use was only 64%.
In an outpatient population with stable CAD of whom a third had angina, there was an increased number of patients with HR > 60 bpm and decreased use of beta-blockers with increasing disease severity. These findings support increased use of newly developed drugs for the treatment of stable CAD and angina.
对门诊环境中患有稳定型冠状动脉疾病（CAD）的人群进行特征描述，并评估静息心率（HR）这一最近被认可的预后危险因素的重要性。
一项前瞻性观察性登记研究，对象为主要由私立门诊心脏病专家随访的稳定型CAD患者。
通过以下至少一项纳入标准选择患者：冠状动脉造影显示至少一处严重狭窄；负荷试验阳性；既往心肌梗死；或接受血管成形术或手术血运重建。记录人口统计学信息、合并疾病、心率（HR）、血压（BP）、心绞痛情况及药物治疗情况。数据汇编和统计分析由一家独立于申办方和研究者的合同研究组织（CRO）进行。
2009年5月至10月期间，186名医生共纳入3477例连续患者。平均年龄为66.6±10.1岁，女性占26.3%，76%患有动脉高血压，34%患有糖尿病，47%有既往梗死史，42%接受血管成形术，25%接受冠状动脉手术。在合并疾病方面，13%的患者患有外周血管疾病或勃起功能障碍。药物治疗包括抗血小板药物（97%）、降脂药物（92%）、β受体阻滞剂（72%）、血管紧张素转换酶抑制剂（ACEIs，54%）、硝酸盐类药物（39%）、钙通道阻滞剂（36%）、血管紧张素Ⅱ受体阻滞剂（ARBs，28%）、伊伐布雷定（24%）和曲美他嗪（17%）。平均心率为67±12次/分钟，67%的患者心率>60次/分钟。平均收缩压为134±18 mmHg，平均舒张压为76±10 mmHg。31.3%的患者有胸痛症状，53.4%为Ⅱ级心绞痛。有胸痛症状的人群病情更严重，74%的人心率>60次/分钟，68%的人正在服用β受体阻滞剂。在有胸痛症状且心率>60次/分钟的患者中，β受体阻滞剂的使用率仅为64%。
在门诊稳定型CAD患者人群中，三分之一有胸痛症状，心率>60次/分钟的患者数量增加，且随着疾病严重程度增加，β受体阻滞剂的使用率降低。这些发现支持增加使用新开发的药物来治疗稳定型CAD和胸痛症状。
