Ambrosio Giuseppe, Mugelli Alessandro, Lopez-Sendón José, Tamargo Juan, Camm John
Division of Cardiology, University of Perugia School of Medicine, Italy.
Department of Neuroscience, Drug Research and Child Health, University of Firenze, Italy.
Eur J Prev Cardiol. 2016 Sep;23(13):1401-12. doi: 10.1177/2047487316648475. Epub 2016 May 24.
In 2013 the European Society of Cardiology (ESC) released new guidelines on the management of stable coronary artery disease. These guidelines update and replace the previous ESC guidelines on the management of stable angina pectoris, issued in 2006. There are several new aspects in the 2013 ESC guidelines compared with the 2006 version. This opinion paper provides an in-depth interpretation of the ESC guidelines with regard to these issues, to help physicians in making evidence-based therapeutic choices in their routine clinical practice. The first new element is the definition of stable coronary artery disease itself, which has now broadened from a 'simple' symptom, angina pectoris, to a more complex disease that can even be asymptomatic. In the first-line setting, the major changes in the new guidelines are the upgrading of calcium channel blockers, the distinction between dihydropyridines and non-dihydropyridine calcium channel blockers, and the presence of important statements regarding the combination of calcium channel blockers with beta-blockers. In the second-line setting, the 2013 ESC guidelines recommend the addition of long-acting nitrates, ivabradine, nicorandil or ranolazine to first-line agents. Trimetazidine may also be considered. However, no clear distinction is made among different second-line drugs, despite different quality of evidence in favour of these agents. For example, the use of ranolazine is supported by strong and recent evidence, while data supporting the use of the traditional agents appear relatively scanty.
2013年，欧洲心脏病学会（ESC）发布了关于稳定型冠状动脉疾病管理的新指南。这些指南更新并取代了ESC于2006年发布的关于稳定型心绞痛管理的先前指南。与2006年版本相比，2013年ESC指南有几个新的方面。本意见书就这些问题对ESC指南进行了深入解读，以帮助医生在日常临床实践中做出基于证据的治疗选择。第一个新要素是稳定型冠状动脉疾病本身的定义，现在已从“简单”症状心绞痛扩展到甚至可能无症状的更复杂疾病。在一线治疗方面，新指南的主要变化是钙通道阻滞剂的升级、二氢吡啶类和非二氢吡啶类钙通道阻滞剂的区分，以及关于钙通道阻滞剂与β受体阻滞剂联合使用的重要声明。在二线治疗方面，2013年ESC指南建议在一线药物中添加长效硝酸盐、伊伐布雷定、尼可地尔或雷诺嗪。曲美他嗪也可考虑使用。然而，尽管支持这些药物的证据质量不同，但在不同的二线药物之间没有明确区分。例如，雷诺嗪的使用得到了有力且最新的证据支持，而支持传统药物使用的数据相对较少。
