Singh Ayesha, Rodman Jack C S, Brown David L
Department of Medicine University of Southern California+Los Angeles General Medical Center, Keck Medicine of USC Los Angeles CA USA.
Southern California Clinical and Translational Science Institute, University of Southern California Los Angeles CA USA.
J Am Heart Assoc. 2025 Jun 17;14(12):e040057. doi: 10.1161/JAHA.124.040057. Epub 2025 Jun 5.
Patients with chronic coronary disease experience less angina with revascularization plus optimal medical therapy compared with optimal medical therapy alone. However, patients may prefer to better understand their individual likelihood of complete angina relief associated with each treatment approach before selecting a strategy. We therefore sought to determine the incidence, predictors, and outcomes of complete angina relief in symptomatic patients treated with invasive management using revascularization plus optimal medical therapy or conservative therapy with optimal medical therapy alone in the ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) trial.
Angina was assessed using the Seattle Angina Questionnaire Angina Frequency (AF) score. We analyzed patients in the invasive management treatment arm with angina at baseline (Seattle Angina Questionnaire Angina Frequency <100) who underwent revascularization and all patients in the conservative therapy arm with angina at baseline. The primary outcome was angina status at 12 months defined as a Seattle Angina Questionnaire Angina Frequency=100 (complete angina relief) or Seattle Angina Questionnaire Angina Frequency <100 (persistent angina). The association of angina status with the composite of cardiovascular death/myocardial infarction was assessed at 5 years.
Among 1376 patients in the conservative therapy arm with angina at baseline, 50% experienced complete angina relief at 12 months. Independent predictors included older age, male sex, recent angina onset, and less baseline angina. Among 1158 patients who underwent revascularization, 70% achieved complete angina relief. Predictors included younger age, nonsmoking, coronary artery bypass graft, and less baseline angina. Cardiovascular death/myocardial infarction rates at 5 years did not differ between patients with or without complete angina relief.
Complete angina relief at 12 months in symptomatic patients with chronic coronary disease was achieved in 70% of patients undergoing revascularization and 50% of patients treated ith conservative therapy and did not influence cardiovascular death/myocardial infarction outcomes.
https://ischemiatrial.org/; ISCHEMIA Trial. Accession Number HLB02742323a.
与单纯的最佳药物治疗相比，慢性冠状动脉疾病患者采用血运重建加最佳药物治疗时心绞痛症状减轻。然而，在选择治疗策略之前，患者可能更希望更好地了解每种治疗方法使心绞痛完全缓解的个体可能性。因此，在缺血性心脏病（医学与侵入性方法比较健康效果国际研究）试验中，我们试图确定采用血运重建加最佳药物治疗的侵入性管理或仅采用最佳药物治疗的保守治疗的有症状患者中，心绞痛完全缓解的发生率、预测因素和结果。
使用西雅图心绞痛问卷心绞痛频率（AF）评分评估心绞痛情况。我们分析了基线时有心绞痛（西雅图心绞痛问卷心绞痛频率<100）且接受血运重建的侵入性管理治疗组患者，以及基线时有心绞痛的保守治疗组所有患者。主要结局是12个月时的心绞痛状态，定义为西雅图心绞痛问卷心绞痛频率=100（心绞痛完全缓解）或西雅图心绞痛问卷心绞痛频率<100（持续性心绞痛）。在5年时评估心绞痛状态与心血管死亡/心肌梗死复合结局之间的关联。
在基线时有心绞痛的1376例保守治疗组患者中，50%在12个月时实现了心绞痛完全缓解。独立预测因素包括年龄较大、男性、近期心绞痛发作以及基线时心绞痛较轻。在1158例接受血运重建的患者中，70%实现了心绞痛完全缓解。预测因素包括年龄较小、不吸烟、冠状动脉搭桥术以及基线时心绞痛较轻。有或无心绞痛完全缓解的患者在5年时的心血管死亡/心肌梗死发生率无差异。
慢性冠状动脉疾病有症状患者中，70%接受血运重建的患者和50%接受保守治疗的患者在12个月时实现了心绞痛完全缓解，且这并未影响心血管死亡/心肌梗死结局。
