Madjlessi-Simon T, Mary-Krause M, Fillette F, Lechat P, Jaillon P
Clinical Pharmacology Unit, Saint-Antoine Hospital, Paris, France.
J Am Coll Cardiol. 1996 Jun;27(7):1586-91. doi: 10.1016/0735-1097(96)00050-2.
We evaluated the prevalence and prognostic significance of transient myocardial ischemia despite beta-adrenergic blockade in patients with coronary artery disease.
Persistence of transient ischemia despite therapy may correspond to a subset of high risk patients with coronary disease. The impact of beta-blocker withdrawal in these patients remains unknown.
Patients (n = 313) with documented coronary artery disease and beta-blocker therapy, with (group I, n = 84) or without (group II, n = 229) transient ischemia on ambulatory electrocardiographic monitoring, were followed up during 21 +/- 9 months for cardiac events (death, myocardial infarction, percutaneous transluminal coronary angioplasty, coronary artery bypass surgery and worsening angina). Occurrence of events was compared by log-rank test.
The number of coronary stenoses did not differ significantly between groups I and II. Beta-blocker therapy was discontinued more frequently during follow-up in group II (25% vs. 14% in group I, p = 0.04). Cumulative percentage of death or myocardial infarction, or both, tended to be higher in group I a 30 months (17% vs. 5% in group II, p = 0.09). Coronary angioplasty and bypass surgery were significantly more frequent in group I (p = 0.01 and 0.0008, respectively). Transient ischemia was associated with a higher cumulative probability of adverse events (p = 0.004). The number of coronary stenoses, presence of transient ischemia and beta-blocker withdrawal were the only significant prognostic factors of cardiac events in the Cox model. In group I patients, the relative hazard of cardiac events was increased threefold when beta-blocker therapy was interrupted.
These data suggest that 1) the occurrence of transient ischemia despite beta-blocker therapy identifies a subset of high risk patients with coronary artery disease, and 2) the interruption of beta-blocker therapy increases the risk of adverse cardiac events.
我们评估了冠心病患者在使用β-肾上腺素能阻滞剂治疗的情况下，短暂性心肌缺血的患病率及其预后意义。
尽管进行了治疗，但短暂性缺血的持续存在可能对应于一部分高危冠心病患者。在这些患者中停用β受体阻滞剂的影响尚不清楚。
对313例有冠心病记录且正在接受β受体阻滞剂治疗的患者进行动态心电图监测，其中有短暂性缺血的患者为I组（n = 84），无短暂性缺血的患者为II组（n = 229），随访21±9个月，观察心脏事件（死亡、心肌梗死、经皮冠状动脉腔内血管成形术、冠状动脉搭桥手术和心绞痛加重）。通过对数秩检验比较事件的发生率。
I组和II组之间冠状动脉狭窄的数量没有显著差异。在随访期间，II组更频繁地停用β受体阻滞剂（25%对I组的14%，p = 0.04）。在30个月时，I组死亡或心肌梗死或两者的累积百分比倾向于更高（17%对II组的5%，p = 0.09）。I组的冠状动脉血管成形术和搭桥手术明显更频繁（分别为p = 0.01和0.0008）。短暂性缺血与不良事件的累积概率较高相关（p = 0.004）。冠状动脉狭窄的数量、短暂性缺血的存在和β受体阻滞剂的停用是Cox模型中心脏事件的唯一显著预后因素。在I组患者中，当β受体阻滞剂治疗中断时，心脏事件的相对风险增加了两倍。
这些数据表明，1）尽管使用了β受体阻滞剂治疗，但短暂性缺血的发生确定了一部分高危冠心病患者，2）β受体阻滞剂治疗的中断会增加不良心脏事件的风险。
