Vervaat Fabienne E, de Vos Annemiek, Schenk Jimmy, Tonino Pim A L, Wijnbergen Inge F
Department of Cardiology, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands.
Department of Methodology, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
J Clin Med. 2025 Jun 9;14(12):4069. doi: 10.3390/jcm14124069.
Up to 40% of patients undergoing a coronary angiogram due to angina pectoris have no obstructive coronary artery disease, also known as angina with non-obstructive coronary arteries (ANOCA). ANOCA is associated with significant impairment in patients' quality of life, increased risk of myocardial infarction and all-cause mortality. Approximately 25% of patients with ANOCA have persisting symptoms despite optimal medical therapy. There is a lack of in-depth knowledge regarding tailored treatment for patients with ANOCA due to a scarcity of trials designed to assess the effect of treatment modalities. The aim of this systematic review and meta-analysis is to give clinicians an overview of the efficacy of current treatment modalities for patients with ANOCA. PudMed/MEDLINE, Embase, the Cochrane Library and clinical trial registries were searched for randomised controlled and cohort studies regarding treatment modalities for ANOCA. The main outcome was change in angina pectoris frequency for each treatment modality. Secondary outcomes included changes in exercise capacity, quality of life, Canadian Cardiovascular Society (CCS) class, coronary flow reserve (CFR) and survival. In total, 80 studies were included and used in the meta-analysis, of which ten studies met the current definition of ANOCA. Angina pectoris frequency improved significantly in the majority of the treatment modalities, with neuromodulation resulting in -3.35 standardised mean difference (SMD) (95% CI: -5.13; -1.56), trimetazidine in -1.74 SMD (-2.63; -0.85), traditional Chinese medicine in -1.55 SMD (-2.36; -0.75), beta-blockers in -1.32 SMD (-1.88; -0.77), enhanced external counterpulsation in -1.27 SMD (-2.04; -0.49), stem cell therapy in -1.04 SMD (-1.51; -0.57), lifestyle interventions in -0.86 SMD (-1.15; -0.57), RAAS-inhibitors in -0.83 SMD (-1.31; -0.35) and calcium channel blockers in -0.64 SMD (-0.92; -0.35). This meta-analysis into treatment modalities for patients with ANOCA shows a significant improvement in angina pectoris frequency in the majority of included treatment modalities. However, these results should be interpreted cautiously, as only ten of the studies included in the meta-analysis meet the current definition of ANOCA. This review underlines the importance of undertaking new studies with existing treatment modalities to determine the efficacy in patients with ANOCA.
因心绞痛接受冠状动脉造影的患者中，高达40%没有阻塞性冠状动脉疾病，也称为非阻塞性冠状动脉性心绞痛（ANOCA）。ANOCA与患者生活质量的显著受损、心肌梗死风险增加和全因死亡率相关。尽管接受了最佳药物治疗，但约25%的ANOCA患者仍有持续症状。由于缺乏旨在评估治疗方式效果的试验，对于ANOCA患者的针对性治疗缺乏深入了解。本系统评价和荟萃分析的目的是让临床医生了解当前治疗方式对ANOCA患者的疗效。在PudMed/MEDLINE、Embase、Cochrane图书馆和临床试验注册库中检索了关于ANOCA治疗方式的随机对照研究和队列研究。主要结局是每种治疗方式下心绞痛频率的变化。次要结局包括运动能力、生活质量、加拿大心血管学会（CCS）分级、冠状动脉血流储备（CFR）和生存率的变化。总共纳入了80项研究并用于荟萃分析，其中10项研究符合ANOCA的当前定义。大多数治疗方式下心绞痛频率有显著改善，神经调节导致标准化均数差（SMD）为-3.35（95%CI：-5.13；-1.56），曲美他嗪为-1.74 SMD（-2.63；-0.85），中药为-1.55 SMD（-2.36；-0.75），β受体阻滞剂为-1.32 SMD（-1.88；-0.77），增强型体外反搏为-1.27 SMD（-2.04；-0.49），干细胞治疗为-1.04 SMD（-1.51；-0.57），生活方式干预为-0.86 SMD（-1.15；-0.57），肾素-血管紧张素-醛固酮系统（RAAS）抑制剂为-0.83 SMD（-1.31；-0.35），钙通道阻滞剂为-0.64 SMD（-0.92；-0.35）。这项针对ANOCA患者治疗方式的荟萃分析表明，大多数纳入的治疗方式下心绞痛频率有显著改善。然而，这些结果应谨慎解释，因为荟萃分析中纳入的研究只有10项符合ANOCA的当前定义。本综述强调了采用现有治疗方式进行新研究以确定其对ANOCA患者疗效的重要性。
