Division of Cardiovascular Medicine, Stanford School of Medicine, Stanford, CA, USA.
Division of Cardiovascular Medicine, Stanford School of Medicine, Stanford, CA, USA.
Int J Cardiol. 2020 Jun 15;309:8-13. doi: 10.1016/j.ijcard.2020.02.014. Epub 2020 Feb 6.
More than 20% of patients presenting to the catheterization lab have no significant obstructive coronary artery disease (CAD) despite having angina. Several occult coronary abnormalities, including endothelial dysfunction, microvascular dysfunction (MVD), and/or a myocardial bridge (MB), may explain their symptoms. We studied the effect of ranolazine on symptoms and quality of life (QOL) in these patients.
We retrospectively studied 53 patients prescribed with ranolazine, matched on sex and age, with 106 patients on standard of care who underwent comprehensive invasive testing. Endothelial dysfunction was defined as a decrease in luminal diameter of >20% after intracoronary acetylcholine, MVD as an index of microvascular resistance ≥25, and a MB as an echolucent half-moon sign and/or ≥10% systolic compression on intravascular ultrasound. A Seattle Angina Questionnaire (SAQ) and SF-12 questionnaire were completed at baseline and follow-up.
Median follow-up was 1.9 (1.7-2.2) years. Endothelial dysfunction was present in 109 (69%), MVD in 36 (23%), and an MB in 86 (54%). Both groups had significant improvement in all dimensions of the SF-12 and SAQ with the exception of treatment satisfaction. We found no significant difference in change in SAQ and SF-12 scores between the groups, although the ranolazine group had significantly lower baseline SAQ scores.
In patients with angina and no obstructive CAD, ranolazine is no different than standard of care in symptomatic and QOL improvement. Further randomized trials are warrented to confirm our findings and identify novel medical therapies in this patient population.
尽管有胸痛，但超过 20%的接受导管实验室检查的患者没有明显的阻塞性冠状动脉疾病（CAD）。一些隐匿性冠状动脉异常，包括内皮功能障碍、微血管功能障碍（MVD）和/或心肌桥（MB），可能解释了他们的症状。我们研究了雷诺嗪对这些患者症状和生活质量（QOL）的影响。
我们回顾性研究了 53 名接受雷诺嗪治疗的患者，按照性别和年龄进行匹配，有 106 名接受标准护理的患者接受了全面的有创性检查。内皮功能障碍定义为冠状动脉内乙酰胆碱后管腔直径减少>20%，MVD 定义为微血管阻力指数≥25，MB 定义为超声心动图上的半透明半月形征象和/或≥10%的收缩期压缩。在基线和随访时完成西雅图心绞痛问卷（SAQ）和 SF-12 问卷。
中位随访时间为 1.9（1.7-2.2）年。内皮功能障碍 109 例（69%），MVD 36 例（23%），MB 86 例（54%）。两组 SF-12 和 SAQ 的所有维度均有显著改善，但治疗满意度除外。尽管雷诺嗪组的 SAQ 基线评分明显较低，但我们发现两组在 SAQ 和 SF-12 评分的变化方面没有显著差异。
在有胸痛且无阻塞性 CAD 的患者中，雷诺嗪在症状和 QOL 改善方面与标准护理无差异。需要进一步的随机试验来证实我们的发现，并确定这一患者群体的新的药物治疗方法。
