Chalon S, Brudi P, Lechat P
Service de Pharmacologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
Therapie. 1995 Mar-Apr;50(2):123-9.
Silent myocardial ischaemia is the most frequent consequence of coronary artery disease and occurs in almost 70 per cent to 80 per cent of ischaemic episodes. In some studies, it has some predictive value of cardiovascular events either in stable or unstable angina or after myocardial infarction. In this last case, one year mortality is 30 per cent and 11 per cent respectively with and without silent ischaemia that has been recorded on the 8th day after myocardial infarction. This review has focused on controlled studies in patients with angina and Holter recorded ischaemia. Nitrates are very likely to be active substances on Holter recorded angina but no controlled studies have been performed to really demonstrate it. The efficacy of beta-blocking agents is well established with a 60 per cent reduction in the number of ischaemic events and a 80 per cent reduction in total ischaemic duration. Nifedipine efficacy appears lower than that of beta-blockers with an evaluated mean reduction of 39 per cent for the number of events and of 43 per cent for duration of episodes. Diltiazem induces a 48 per cent reduction of both ischaemic parameters. For drug associations, addition of a calcium antagonist to a beta-blocking agent provides only little benefit. The relationship between anti-ischaemic efficacy and long term prevention of cardiovascular events remains to be established for a given anti-ischaemic therapy.
无症状性心肌缺血是冠状动脉疾病最常见的后果，几乎70%至80%的缺血发作都会出现。在一些研究中，它对稳定型或不稳定型心绞痛患者或心肌梗死后的心血管事件具有一定的预测价值。在后一种情况下，心肌梗死后第8天记录有无症状性缺血和无无症状性缺血的患者，一年死亡率分别为30%和11%。本综述聚焦于对心绞痛患者和动态心电图记录的缺血进行的对照研究。硝酸盐很可能是对动态心电图记录的心绞痛有效的物质，但尚未进行对照研究来真正证实这一点。β受体阻滞剂的疗效已得到充分证实，缺血事件数量减少60%，总缺血持续时间减少80%。硝苯地平的疗效似乎低于β受体阻滞剂，事件数量平均减少39%，发作持续时间减少43%。地尔硫卓使两个缺血参数均降低48%。对于联合用药，在β受体阻滞剂中加用钙拮抗剂仅带来很少益处。对于特定的抗缺血治疗，抗缺血疗效与心血管事件长期预防之间的关系仍有待确定。
