Therapeutic approaches in exertional angina pectoris

Česká verzia

Authors: K. Kopřiva
Authors place of work: Kardiocentrum, Nemocnice Na Homolce, Praha
Published in the journal: Kardiol Rev Int Med 2015, 17(3): 225-229
Category: Cardiology Review

Summary

Stable exertional angina pectoris is a common manifestation of coronary artery disease. The treatment of angina involves pharmacological therapy and revascularization procedures. In all patients secondary prevention measures must be apllied and the treatment of anginal symptoms should start by medical intervention. Revascularization should be dedicated for patients with severe symptoms regardless of medication therapy and for patients in high cardiovascular risk. For prognostic stratification several methods can be used including clinical evaluation, left ventricular function assessment, stress tests and coronary angiography. Treatment of refractory angina is specific and includes some new pharmacological and non‑pharmacological options. In this article we present an overview of current treatment of stable angina pectoris.

Key words:
coronary artery disease – angina pectoris – pharmacological therapy

Zdroje

1. Montalescot G, Sechtem U, Achenbach S et al.2013 ESC guidelines on the management of stable coronary artery disease The Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J 2013; 34: 2949– 3003. doi: 10.1093/ eurheartj/ eht296.

2. Henderson RA, Pocock SJ, Clayton TC et al. Seven‑year outcome in the RITA‑ 2 trial: coronary angioplasty versus medical therapy. J Am Coll Cardiol 2003; 42: 1161– 1170.

3. Boden WE, O’Rourke RA, Teo KK et al. Optimal medical therapy with or without PCI for stable coronary disease. N Eng J Med 2007; 356: 1503– 1516.

4. Steg PG, Bhatt DL, Wilson PW et al. One‑year cardiovascular event. rates in outpatients with atherothrombosis. JAMA 2007; 297: 1197– 1206.

5. Mozaffarian D, Bryson CL, Spertus JA et al. Anginal symptoms consistently predict total mortality among outpatients with coronary artery disease. Am Heart J 2003; 146: 1015– 1022.

6. Emond M, Mock MB, Davis KB et al. Long‑term survival of medically treated patients in the Coronary Artery Surgery Study (CASS) Registry. Circulation 1994; 90: 2645– 2657.

7. Brown KA. Prognostic value of thallium‑ 201 myocardial perfusion imaging. A diagnostic tool comes of age. Circulation 1991; 83: 363– 381.

8. Hammermeister KE, DeRouen TA, Dodge HT. Variables predictive of survival in patients with coronary disease. Selection by univariate and multivariate analyses from the clinical, electrocardiographic, exercise, arteriographic, and quantitative angiographic evaluations. Circulation 1979; 59: 421– 430.

9. Mark DB, Nelson CL, Califf RM et al. Continuing evolution of therapy for coronary artery disease. Initial results from the era of coronary angioplasty. Circulation 1994; 89: 2015– 2025.

10. Califf RM, Armstrong PW, Carver JR et al. 27th Bethesda Conference: matching the intensity of risk factor management with the hazard for coronary disease events. Task Force 5. Stratification of patients into high, medium and low risk subgroups for purposes of risk factor management. J Am Coll Cardiol 1996; 27: 1007– 1019.

11. Gurbel PA, Bliden KP, Butler K et al. Randomized double‑blind assessment of the ONSET and OFFSET of the antiplatelet effects of ticagrelor versus clopidogrel in patients with stable coronary artery disease: theONSET/ OFFSET study. Circulation 2009; 120: 2577– 2585. doi: 10.1161/ CIRCULATIONAHA.109.912550.

12. Jernberg T, Payne CD, Winters KJ et al. Prasugrel achieves greater inhibition of platelet aggregation and a lower rate of non‑responders compared with clopidogrel in aspirin‑treated patients with stable coronary artery disease. Eur Heart J 2006; 27: 1166– 1173.

13. Yusuf S, Sleight P, Pogue J et al. Effects of an angiotensin‑converting enzyme inhibitor, ramipril, on cardiovascular events in high‑risk patients. The Heart Outcomes Prevention Evaluation Study investigators. N Engl J Med 2000; 342: 145– 153.

14. Fox KM. The EUROPA Executive Committee. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: a randomised, double‑blind, placebo‑ controlled, multicentre trial (the EUROPA study). Lancet 2003; 362: 782– 788.

15. Yusuf S, Teo KK, Pogue J et al. The ONTARGET Investigators. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med 2008; 358: 1547– 1559. doi: 10.1056/ NEJMoa0801317.

16. Fox KM, Ford I, Steg G et al. Relationship between ivabradine treatment and cardiovascular outcomes in patients with stable coronary artery disease and left ventricular systolic dysfunction with limiting angina: a subgroup analysis of the randomized, controlled BEAUTIFUL trial. Eur Heart J 2009; 30: 2337– 2345. doi: 10.1093/ eurheartj/ ehp358.

17. Izumiya Y, Kojima S, Kojima S et al. Long‑term use of oral nicorandil stabilizes coronary plaque in patients with stable angina pectoris. Atherosclerosis 2011; 214: 415– 421. doi: 10.1016/ j.atherosclerosis.2010.11.032.

18. Morrow DA, Scirica BM, Chaitman BR et al. Evaluation of the glycometabolic effects of ranolazine in patients with and without diabetes mellitus in the MERLIN‑ TIMI 36 randomized controlled trial. Circulation 2009; 119: 2032– 2039. doi: 10.1161/ CIRCULATIONAHA.107.763912.

19. Wilson SR, Scirica BM, Braunwald E et al. Efficacy of ranolazine in patients with chronic angina observations from the randomized, double‑blind, placebo controlled MERLIN‑ TIMI (Metabolic Efficiency With Ranolazine for Less Ischemia in Non‑ ST‑Segment Elevation Acute Coronary Syndromes) 36 Trial. J Am Coll Cardiol 2009; 53: 1510– 1516. doi: 10.1016/ j.jacc.2009.01.037.

20. Kosiborod M, Arnold SV, Spertus JA et al. Evaluation of ranolazine in patients with type 2 diabetes mellitus and chronic stable angina. results from the TERISA randomized clinical trial. J Am Coll Cardiol 2013; 61: 2038– 2045. doi: 10.1016/ j.jacc.2013.02.011.

21. Noman A, Ang DS, Ogston S et al. Effect of high‑dose allopurinol on exercise in patients with chronic stable angina: a randomised, placebo controlled crossover trial. Lancet 2010; 375: 2161– 2167. doi: 10.1016/ S0140- 6736(10)60391- 1.

22. Andrell P, Yu W, Gersbach P et al. Long‑term effects of spinal cord stimulation on angina symptoms and quality of life in patients with refractory angina pectoris: results from the European Angina Registry Link Study (EARL). Heart 2010; 96: 1132– 1136. doi: 10.1136/ hrt.2009.177188.

23. Arora RR, Chou TM, Jain D et al. The multicenter study of enhanced external counterpulsation (MUST‑EECP): effect of EECP on exercise‑induced myocardial ischemia and anginal episodes. J Am Coll Cardiol 1999; 33: 1833– 1840.