National Heart and Lung Institute, Imperial College, Guy Scadding Building, Dovehouse Street, London SW3 6LY, UK.
Royal Brompton & Harefield Hospitals, London, UK.
Eur Heart J. 2021 Jan 20;42(3):269-283. doi: 10.1093/eurheartj/ehaa820.
Despite the use of anti-anginal drugs and/or percutaneous coronary interventions (PCI) or coronary artery bypass grafting, the proportion of patients with coronary artery disease who have daily or weekly angina ranges from 2% to 24%. Refractory angina refers to long-lasting symptoms (for >3 months) due to established reversible ischaemia, which cannot be controlled by escalating medical therapy with the use of 2nd- and 3rd-line pharmacological agents, bypass grafting, or stenting. While there is uncertain prognostic benefit, the treatment of refractory angina is important to improve the quality of life of the patients affected. This review focuses on conventional pharmacological approaches to treating refractory angina, including guideline directed drug combination and dosages. The symptomatic and prognostic impact of advanced and novel revascularization strategies such as chronic total occlusion PCI, transmyocardial laser revascularization, coronary sinus occlusion, radiation therapy for recurrent restenosis, and spinal cord stimulation are also covered and recommendations of the 2019 ESC Guidelines on the Diagnosis and Management of Chronic Coronary Syndromes discussed. Finally, the potential clinical use of current angiogenetic and stem cell therapies in reducing ischaemia and/or pain is evaluated.
尽管使用了抗心绞痛药物和/或经皮冠状动脉介入治疗（PCI）或冠状动脉旁路移植术，但患有冠心病的患者中，每日或每周有心绞痛的比例为 2%至 24%。难治性心绞痛是指由于已确定的可逆转缺血引起的持续时间较长的症状（>3 个月），不能通过使用二线和三线药物、旁路移植术或支架来加强药物治疗来控制。尽管预后不确定，但治疗难治性心绞痛对于改善受影响患者的生活质量很重要。这篇综述重点介绍了治疗难治性心绞痛的常规药物治疗方法，包括指南指导的药物联合用药和剂量。还涵盖了慢性完全闭塞 PCI、心肌激光血运重建、冠状窦闭塞、复发性再狭窄的放射治疗和脊髓刺激等先进和新型血运重建策略的症状和预后影响，并讨论了 2019 ESC 慢性冠状动脉综合征诊断和管理指南的建议。最后，评估了当前血管生成和干细胞治疗在减少缺血和/或疼痛方面的潜在临床应用。
