Meinertz T, Köster R
Klinik für Allgemeine und Interventionelle Kardiologie, Universitäres Herzzentrum, Martinistraße 52, 20246, Hamburg.
Internist (Berl). 2011 Jul;52(7):894-6, 898-900. doi: 10.1007/s00108-011-2854-z.
There is a renaissance of medical treatment of chronic angina pectoris despite of advances in interventional therapy. New drugs include nicorandil, ivabradine and ranolazine. Nicorandil dilates venous and arterial vessels via relaxation of smooth muscle cells. Since the drug has only recently been approved, the German experience is limited. Ivabradine exerts an anti-anginous effect by selective action on the sinus node with reduction of heart rate. Multiple studies have demonstrated its anti-anginal efficacy, which has also been shown if it was used as an additional therapy to classic anti-anginal treatment. Its use is reasonable as a substitute for beta-blockers or as an "add-on therapy" combined with beta-blockers, if the target heart rate for treatment of angina pectoris has not been reached. Ranolazine delays the late sodium current into the myocytes. Thereby, it improves the diastolic ventricular function and the microcirculation of the myocardium. Several large studies confirmed the anti-anginal efficacy of the drug. Currently it is used if angina pectoris still occurs under a combined treatment with different classic anti-anginal drugs.
尽管介入治疗取得了进展，但慢性心绞痛的药物治疗正在复兴。新药包括尼可地尔、伊伐布雷定和雷诺嗪。尼可地尔通过舒张平滑肌细胞来扩张静脉和动脉血管。由于该药物最近才被批准，德国的经验有限。伊伐布雷定通过对窦房结的选择性作用降低心率，从而发挥抗心绞痛作用。多项研究已证实其抗心绞痛疗效，在作为经典抗心绞痛治疗的附加疗法使用时也显示出了这种疗效。如果未达到治疗心绞痛的目标心率，将其用作β受体阻滞剂的替代品或与β受体阻滞剂联合的“附加疗法”是合理的。雷诺嗪延缓钠电流进入心肌细胞。因此，它改善了心室舒张功能和心肌微循环。几项大型研究证实了该药物的抗心绞痛疗效。目前，在与不同的经典抗心绞痛药物联合治疗仍有心绞痛发作时使用该药物。
