Treatment of chronic stable angina pectoris.
Treatment of chronic stable angina pectoris.
复制标题
治疗慢性稳定性心绞痛。
DOI：
10.1016/0002-9149(92)90022-q
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发表时间：
1992
影响因子：
2.8
通讯作者：
R. Gorlin
中科院分区：
文献类型：
--
作者：
R. Gorlin
心绞痛患者可根据临床表现和仔细的检查（可能包括应激诱导的异常灌注或收缩模式的核成像和冠状动脉造影）分为低风险或高风险类别。高风险患者可能需要通过血管成形术或旁路手术进行血运重建，而低风险患者可以通过药物进行管理。重要的是要考虑各种抗缺血药物对心肌供需方程的影响。最近的一项研究表明，β受体阻滞剂与单硝酸异山梨酯的组合在增加运动持续时间方面比β受体阻滞剂与钙拮抗剂的组合或三联疗法更有效。在单支血管病变患者中，血管成形术已被证明在缓解症状方面比药物治疗更有效，但再狭窄的发生率和相关费用较高。手术对左主干冠状动脉疾病或3支病变伴左心室损害患者的死亡率有有利影响。新的证据表明，内皮功能障碍可能发挥更重要的作用，在慢性稳定型心绞痛pectorls比已经认识到，这种功能障碍可以治疗硝酸盐。
Patients with angina pectoris may be stratified into low- or high-risk categories on the basis of clinical findings and a careful workup, possibly including nuclear imaging of stress-induced abnormal perfusion or contractile patterns and coronary angiography. High-risk patients may require revascularization by angioplasty or bypass surgery, whereas low-risk patients can be managed medically. It Is important to consider the impact of various anti-ischemic drugs on the myocardlal demand-supply equation. A recent study indicated that the combination of a β blocker plus isosorbide mononitrate is more effective in increasing exercise duration than is either the combination of a β blocker and a calcium antagonist or triple therapy. In patients with single-vessel disease, angioplasty has been shown to be more effective than medical therapy in relieving symptoms, but the incidence of restenosis and the associated costs are high. Surgery favorably affects mortality in patients with left main coronary artery disease or 3-vessel disease with left ventricular impairment. New evidence suggests that endothelial dysfunction may play a more important role in chronic stable angina pectorls than has been appreciated and that such dysfunction may be treated with nitrates.