Lanza Gaetano Antonio, Shimokawa Hiroaki
Fondazione Policlinico A Gemelli IRCCS, Department of Cardiovascular Medicine, Università Cattolica del Sacro Cuore Rome, Italy.
International University of Health and Welfare Narita, Japan.
Eur Cardiol. 2023 May 22;18:e38. doi: 10.15420/ecr.2022.47. eCollection 2023.
Calcium channel blockers (CCBs) are the first-line treatment for coronary artery spasm (CAS). When CAS-related angina symptoms are not well controlled by CCB therapy, long-acting nitrates or (where available) nicorandil can be added as second-line medications. In the case of CAS refractory to standard treatments, several other alternative drugs and interventions have been proposed, including the Rho-kinase inhibitor fasudil, anti-adrenergic drugs, neural therapies and percutaneous coronary interventions. In patients with syncope or cardiac arrest caused by CAS-related tachyarrhythmias, or even bradyarrhythmias, implantation of an ICD or pacemaker, respectively, should be considered according to the risk of recurrence and efficacy of vasodilator therapy.
钙通道阻滞剂（CCB）是冠状动脉痉挛（CAS）的一线治疗药物。当CCB治疗不能很好地控制与CAS相关的心绞痛症状时，长效硝酸盐类药物或（如有）尼可地尔可作为二线药物添加使用。对于标准治疗无效的CAS患者，已提出了其他几种替代药物和干预措施，包括Rho激酶抑制剂法舒地尔、抗肾上腺素能药物、神经疗法和经皮冠状动脉介入治疗。对于由CAS相关的快速性心律失常甚至缓慢性心律失常引起晕厥或心脏骤停的患者，应根据复发风险和血管扩张剂治疗的疗效，分别考虑植入植入式心律转复除颤器（ICD）或起搏器。
