-
Heart (British Cardiac Society) Mar 2020
Review
Topics: Angina Pectoris; Humans; Practice Guidelines as Topic
PubMed: 32054665
DOI: 10.1136/heartjnl-2018-314661 -
Nature Reviews. Cardiology Feb 2018In clinical guidelines, drugs for symptomatic angina are classified as being first choice (β-blockers, calcium-channel blockers, short-acting nitrates) or second choice... (Review)
Review
In clinical guidelines, drugs for symptomatic angina are classified as being first choice (β-blockers, calcium-channel blockers, short-acting nitrates) or second choice (ivabradine, nicorandil, ranolazine, trimetazidine), with the recommendation to reserve second-choice medications for patients who have contraindications to first-choice agents, do not tolerate them, or remain symptomatic. No direct comparisons between first-choice and second-choice treatments have demonstrated the superiority of one group of drugs over the other. Meta-analyses show that all antianginal drugs have similar efficacy in reducing symptoms, but provide no evidence for improvement in survival. The newer, second-choice drugs have more evidence-based clinical data that are more contemporary than is available for traditional first-choice drugs. Considering some drugs, but not others, to be first choice is, therefore, difficult. Moreover, double or triple therapy is often needed to control angina. Patients with angina can have several comorbidities, and symptoms can result from various underlying pathophysiologies. Some agents, in addition to having antianginal effects, have properties that could be useful depending on the comorbidities present and the mechanisms of angina, but the guidelines do not provide recommendations on the optimal combinations of drugs. In this Consensus Statement, we propose an individualized approach to angina treatment, which takes into consideration the patient, their comorbidities, and the underlying mechanism of disease.
Topics: Angina Pectoris; Cardiology; Cardiovascular Agents; Clinical Decision-Making; Comorbidity; Consensus; Humans; Patient Selection; Patient-Centered Care; Risk Assessment; Risk Factors; Treatment Outcome
PubMed: 28880025
DOI: 10.1038/nrcardio.2017.131 -
Circulation Journal : Official Journal... May 2023
Topics: Humans; Coronary Vasospasm; Muscle Spasticity; Angina Pectoris, Variant; Angina Pectoris; Myocardial Ischemia; Coronary Angiography
PubMed: 36908169
DOI: 10.1253/circj.CJ-22-0779 -
Expert Opinion on Investigational Drugs Dec 2016Ischemic heart disease (IHD) is a major cause of death and disability among Western countries and angina pectoris is the most prevalent symptomatic manifestation.... (Review)
Review
Ischemic heart disease (IHD) is a major cause of death and disability among Western countries and angina pectoris is the most prevalent symptomatic manifestation. Strategies to improve management of chronic stable angina are a priority. Areas covered: A comprehensive review was conducted using the Medline and Cochrane databases as well as the clinical trial databases in the United States and Europe. Traditional therapies for angina will be discussed. This review particularly emphasizes investigational therapies for angina (including pharmacological agents, cell and gene based therapies, and herbal medications). Expert opinion: There has been renewed interest in older anti-angina agents (e.g., perhexiline, amiodarone, and phosphodiestrase-5 inhibitors). Other anti-inflammatory agents (e.g., allopurinol and febuxostat) are currently undergoing evaluation for angina therapy. Therapeutic angiogenesis continues to face some challenges. Future trials should evaluate the optimum patient population that would benefit from this form of therapy.
Topics: Angina Pectoris; Angina, Stable; Cardiovascular Agents; Cell- and Tissue-Based Therapy; Drugs, Investigational; Genetic Therapy; Humans; Myocardial Ischemia
PubMed: 27791405
DOI: 10.1080/13543784.2016.1254617 -
Clinical Cardiology Feb 2007William Heberden in 1772 published "some account of the disorder of the breast" which contains the essential elements of angina pectoris as we understand it today. The... (Review)
Review
William Heberden in 1772 published "some account of the disorder of the breast" which contains the essential elements of angina pectoris as we understand it today. The number of existing cases in the U.S. population today is 6.4 million. Myocardial ischemia manifested by angina pectoris can be either acute or chronic. Patients with chronic stable angina will be the focus of this supplement. The majority of patients are symptomatic but approximately 25% can be asymptomatic. The clinical manifestations of myocardial ischemia generally are chest discomfort, arrhythmias, and LV dysfunction. Myocardial ischemia is a result of imbalance between myocardial oxygen supply and myocardial oxygen demand. High grade coronary stenosis are the usual cause of decreased oxygen supply. The classic hemodynamic factors increasing myocardial oxygen demand include hypertension and increased heart rate due to tachyarrhythmias of any etiology. Exertion is the usual precipitating cause of chronic myocardial ischemia. New information has come forward indicating that myocardial ischemia is associated with disruption of cellular sodium and calcium homeostasis. Ischemia results in a rise of intracellular sodium concentration and thus sodium overload which then activates the sodium calcium exchanger and leads to increased intracellular calcium. When this occurs there is electrical instability and mechanical dysfunction which increases oxygen demand and decreases oxygen supply. The compound Ranolazine is thought to selectively inhibit the late sodium current and attenuates the abnormalities of ventricular repolarization and contractility associated with myocardial ischemia. This compound is the first new class of anti-anginal medication approved in 25 years which may provide physicians with additional therapy for chronic stable angina along with the other anti-angina agents, beta blockers, calcium antagonists and nitrates.
Topics: Angina Pectoris; Calcium; History, 18th Century; Humans; Myocardial Ischemia; Myocardium; Oxygen; Prevalence; Sodium
PubMed: 18373324
DOI: 10.1002/clc.20041 -
Medicina (Kaunas, Lithuania) Feb 2023Coronary artery spasm (CAS) is a dynamic coronary stenosis causing vasospastic angina (VSA). However, VSA is a potentially lethal medical condition with multiple... (Review)
Review
Coronary artery spasm (CAS) is a dynamic coronary stenosis causing vasospastic angina (VSA). However, VSA is a potentially lethal medical condition with multiple presentations, including sudden cardiac death. Despite investigations to explore its pathogenesis, no single mechanism has been found to explain the entire process of VSA occurrence. The roles of elevated local and systemic inflammation have been increasingly recognized in VSA. Treatment strategies to decrease local and systemic inflammation deserve further investigation.
Topics: Humans; Coronary Vasospasm; Angina Pectoris; Inflammation; Coronary Angiography
PubMed: 36837519
DOI: 10.3390/medicina59020318 -
JACC. Cardiovascular Interventions Dec 2022
Topics: Humans; Treatment Outcome; Angina Pectoris; Coronary Artery Disease
PubMed: 36543446
DOI: 10.1016/j.jcin.2022.10.036 -
Circulation. Cardiovascular... Apr 2023Twenty percent to 40% of patients are affected by angina after percutaneous coronary intervention (PCI), which is associated with anxiety, depression, impaired physical... (Clinical Trial)
Clinical Trial
BACKGROUND
Twenty percent to 40% of patients are affected by angina after percutaneous coronary intervention (PCI), which is associated with anxiety, depression, impaired physical function, and reduced quality of life. Understanding patient and procedural factors associated with post-PCI angina may inform alternative approaches to treatment.
METHODS
Two hundred thirty patients undergoing PCI completed the Seattle Angina Questionnaire (SAQ-7) and European quality of life-5 dimension-5 level (EQ-5D-5L) questionnaires at baseline and 3 months post-PCI. Patients received blinded intracoronary physiology assessments before and after stenting. A post hoc analysis was performed to compare clinical and procedural characteristics among patients with and without post-PCI angina (defined by follow-up SAQ-angina frequency score <100).
RESULTS
Eighty-eight of 230 patients (38.3%) reported angina 3 months post-PCI and had a higher incidence of active smoking, atrial fibrillation, and history of previous myocardial infarction or PCI. Compared with patients with no angina at follow-up, they had lower baseline SAQ summary scores (69.48±24.12 versus 50.20±22.59, <0.001) and EQ-5D-5L health index scores (0.84±0.15 versus 0.69±0.22, <0.001). Pre-PCI fractional flow reserve (FFR) was lower among patients who had no post-PCI angina (0.56±0.15 versus 0.62±0.13, =0.003). Percentage change in FFR after PCI had a moderate correlation with angina frequency score at follow-up (=0.36, <0.0001). Patients with post-PCI angina had less improvement in FFR (43.1±33.5% versus 67.0±50.7%, <0.001). There were no between-group differences in post-PCI FFR, coronary flow reserve, or corrected index of microcirculatory resistance. Patients with post-PCI angina had lower SAQ-summary scores (64.01±22 versus 95.16±8.72, ≤0.001) and EQ-5D-5L index scores (0.69±0.26 versus 0.91±0.17, ≤0.001) at follow-up.
CONCLUSIONS
Larger improvements in FFR following PCI were associated with less angina and better quality of life at follow-up. In patients with stable symptoms, intracoronary physiology assessment can inform expectations of angina relief and quality of life improvement after stenting and thereby help to determine the appropriateness of PCI.
REGISTRATION
URL: https://www.
CLINICALTRIALS
gov; Unique identifier: NCT03259815.
Topics: Humans; Angina Pectoris; Coronary Angiography; Coronary Artery Disease; Fractional Flow Reserve, Myocardial; Microcirculation; Percutaneous Coronary Intervention; Quality of Life; Treatment Outcome
PubMed: 36974680
DOI: 10.1161/CIRCINTERVENTIONS.122.012511 -
European Heart Journal Aug 2019Persistence or recurrence of angina after a percutaneous coronary intervention (PCI) may affect about 20-40% of patients during short-medium-term follow-up. This appears... (Review)
Review
Persistence or recurrence of angina after a percutaneous coronary intervention (PCI) may affect about 20-40% of patients during short-medium-term follow-up. This appears to be true even when PCI is 'optimized' using physiology-guided approaches and drug-eluting stents. Importantly, persistent or recurrent angina post-PCI is associated with a significant economic burden. Healthcare costs may be almost two-fold higher among patients with persistent or recurrent angina post-PCI vs. those who become symptom-free. However, practice guideline recommendations regarding the management of patients with angina post-PCI are unclear. Gaps in evidence into the mechanisms of post-PCI angina are relevant, and more research seems warranted. The purpose of this document is to review potential mechanisms for the persistence or recurrence of angina post-PCI, propose a practical diagnostic algorithm, and summarize current knowledge gaps.
Topics: Algorithms; Angina Pectoris; Humans; Percutaneous Coronary Intervention; Recurrence
PubMed: 30608528
DOI: 10.1093/eurheartj/ehy857 -
EuroIntervention : Journal of EuroPCR... Apr 2021
Topics: Angina Pectoris; Humans
PubMed: 33792542
DOI: 10.4244/EIJV16I18A265