Hammond-Haley Matthew, Chiew Kayla, Ahmed-Jushuf Fiyyaz, Rajkumar Christopher A, Foley Michael J, Simader Florentina A, Chotai Shayna, Shun-Shin Matthew J, Al-Lamee Rasha
National Heart and Lung Institute, Imperial College London, London, United Kingdom.
EuroIntervention. 2025 Jan 6;21(1):46-57. doi: 10.4244/EIJ-D-24-00404.
Microvascular angina (MVA) is an important contributor to morbidity and mortality in patients with non-obstructive coronary artery disease. Despite improvements in its recognition and diagnosis, uncertainty remains around the most effective treatment strategy, and more data are needed.
We aimed to evaluate the quality of patient selection in treatment studies of MVA and provide a contemporary overview of the evidence base for the treatment of MVA.
PubMed, the Cochrane Library and Google Scholar were searched from inception to 4 November 2023 for all treatment studies in patients with angina and non-obstructive coronary artery disease or coronary microvascular dysfunction. Populations with acute coronary syndrome were excluded (PROSPERO: CRD42023383075).
Forty-three studies were included. By contemporary definitions of MVA according to the Coronary Vasomotor Disorders International Study Group criteria, 11 (26%) studies enrolled patients with "definitive" MVA, 24 (56%) with "suspected" MVA, and 8 (19%) did not enrol patients who met the diagnostic criteria. A total of 24 unique treatment interventions were investigated. Most studies were observational and single armed (12/24, 50%) or had a single randomised study (9/24, 38%). Ranolazine is the most well-studied intervention drug. Double-blind randomised controlled trials of ranolazine (n=6) have shown inconsistent improvements in Seattle Angina Questionnaire scores and coronary flow reserve with short-term follow-up.
Treatment studies of MVA enrolled a heterogeneous population, with only a quarter meeting contemporary diagnostic criteria for definitive MVA. There is a paucity of high quality, randomised data to support any specific treatment intervention. Larger studies with robust selection criteria, blinded patient-reported outcomes, and long-term follow-up are needed.
微血管性心绞痛（MVA）是无阻塞性冠状动脉疾病患者发病和死亡的重要因素。尽管在其识别和诊断方面有所改善，但围绕最有效的治疗策略仍存在不确定性，需要更多数据。
我们旨在评估MVA治疗研究中患者选择的质量，并提供MVA治疗证据基础的当代概述。
从创刊至2023年11月4日，检索PubMed、Cochrane图书馆和谷歌学术，查找所有关于心绞痛和无阻塞性冠状动脉疾病或冠状动脉微血管功能障碍患者的治疗研究。排除急性冠状动脉综合征患者群体（国际前瞻性系统评价注册库：CRD42023383075）。
纳入43项研究。根据国际冠状动脉血管舒缩障碍研究组标准对MVA的当代定义，11项（26%）研究纳入“确诊”MVA患者，24项（56%）纳入“疑似”MVA患者，8项（19%）未纳入符合诊断标准的患者。共研究了24种独特的治疗干预措施。大多数研究为观察性且单臂（12/24，50%）或仅有一项随机研究（9/24，38%）。雷诺嗪是研究最多的干预药物。雷诺嗪的双盲随机对照试验（n = 6）显示，短期随访时西雅图心绞痛问卷评分和冠状动脉血流储备的改善不一致。
MVA治疗研究纳入的人群异质性较大，只有四分之一符合当代确诊MVA的诊断标准。缺乏高质量的随机数据来支持任何特定的治疗干预措施。需要进行更大规模的研究，采用严格筛选标准、患者报告结局设盲并进行长期随访。
