Chronic Stable Angina

2017 ◽  
Author(s):  
Benjamin J Scirica ◽  
J. Antonio T. Gutierrez
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Heart Disease ◽  
Percutaneous Coronary Intervention ◽  
Heart Disease ◽  
Coronary Artery ◽  
Stable Angina ◽  
Chronic Stable Angina ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
Artery Disease

By definition, chronic stable angina is angina that has been stable with regard to frequency and severity for at least 2 months. Chronic stable angina is the initial manifestation of coronary heart disease in approximately 50% of patients. Typically, this type of angina occurs in the setting of atherosclerotic coronary arterial narrowing, although other causes are possible. This review covers the epidemiology, pathophysiology, initial evaluation, differential diagnosis, management, and treatment of patients with chronic stable angina. Figures show noninvasive testing and the probability of coronary artery disease; diagnosis of patients with suspected ischemic heart disease; probability of severe coronary artery disease; coronary outcomes for high- versus low-intensity statin therapy; optimal medical therapy (OMT) versus OMT and percutaneous coronary intervention for chronic angina; OMT versus percutaneous coronary intervention for stable coronary heart disease; and coronary artery bypass grafting versus percutaneous coronary intervention for diabetes and coronary artery disease. Tables list the grading of angina pectoris by the Canadian Cardiovascular Society classification system, the differential diagnosis of chest pain, conditions promoting myocardial oxygen supply and demand mismatch, the features of typical angina, the classification of chest pain, a comparison of the pretest likelihood of coronary heart disease (CHD) in low-risk and high-risk symptomatic patients, the posttest probability of significant CHD based on pretest probabilities of CHD and normal or abnormal results of noninvasive studies, survival according to risk groups based on Duke treadmill scores, high- and moderate-intensity statin therapy, revascularization to improve survival compared with medical therapy, revascularization to improve symptoms with significant anatomic (≥ 50% left main or ≥ 70% nonleft main coronary artery disease) or physiologic (fractional flow reserve ≤ 0.80) coronary artery stenoses, and questions recommended by an expert panel for patients with chronic stable angina at follow-up visits. This review contains 7 highly rendered figures, 13 tables, and 109 references.

Chronic Stable Angina

2015 ◽  
Author(s):  
Benjamin J Scirica ◽  
J. Antonio T. Gutierrez
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Heart Disease ◽  
Percutaneous Coronary Intervention ◽  
Heart Disease ◽  
Coronary Artery ◽  
Stable Angina ◽  
Chronic Stable Angina ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
Artery Disease

By definition, chronic stable angina is angina that has been stable with regard to frequency and severity for at least 2 months. Chronic stable angina is the initial manifestation of coronary heart disease in approximately 50% of patients. Typically, this type of angina occurs in the setting of atherosclerotic coronary arterial narrowing, although other causes are possible. This review covers the epidemiology, pathophysiology, initial evaluation, differential diagnosis, management, and treatment of patients with chronic stable angina. Figures show noninvasive testing and the probability of coronary artery disease; diagnosis of patients with suspected ischemic heart disease; probability of severe coronary artery disease; coronary outcomes for high- versus low-intensity statin therapy; optimal medical therapy (OMT) versus OMT and percutaneous coronary intervention for chronic angina; OMT versus percutaneous coronary intervention for stable coronary heart disease; and coronary artery bypass grafting versus percutaneous coronary intervention for diabetes and coronary artery disease. Tables list the grading of angina pectoris by the Canadian Cardiovascular Society classification system, the differential diagnosis of chest pain, conditions promoting myocardial oxygen supply and demand mismatch, the features of typical angina, the classification of chest pain, a comparison of the pretest likelihood of coronary heart disease (CHD) in low-risk and high-risk symptomatic patients, the posttest probability of significant CHD based on pretest probabilities of CHD and normal or abnormal results of noninvasive studies, survival according to risk groups based on Duke treadmill scores, high- and moderate-intensity statin therapy, revascularization to improve survival compared with medical therapy, revascularization to improve symptoms with significant anatomic (≥ 50% left main or ≥ 70% nonleft main coronary artery disease) or physiologic (fractional flow reserve ≤ 0.80) coronary artery stenoses, and questions recommended by an expert panel for patients with chronic stable angina at follow-up visits. This review contains 7 highly rendered figures, 12 tables, and 109 references.

Chronic Stable Angina

2018 ◽  
Author(s):  
Benjamin J Scirica ◽  
J. Antonio T. Gutierrez
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Heart Disease ◽  
Percutaneous Coronary Intervention ◽  
Heart Disease ◽  
Coronary Artery ◽  
Stable Angina ◽  
Chronic Stable Angina ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
Artery Disease

By definition, chronic stable angina is angina that has been stable with regard to frequency and severity for at least 2 months. Chronic stable angina is the initial manifestation of coronary heart disease in approximately 50% of patients. Typically, this type of angina occurs in the setting of atherosclerotic coronary arterial narrowing, although other causes are possible. This review covers the epidemiology, pathophysiology, initial evaluation, differential diagnosis, management, and treatment of patients with chronic stable angina. Figures show noninvasive testing and the probability of coronary artery disease; diagnosis of patients with suspected ischemic heart disease; probability of severe coronary artery disease; coronary outcomes for high- versus low-intensity statin therapy; optimal medical therapy (OMT) versus OMT and percutaneous coronary intervention for chronic angina; OMT versus percutaneous coronary intervention for stable coronary heart disease; and coronary artery bypass grafting versus percutaneous coronary intervention for diabetes and coronary artery disease. Tables list the grading of angina pectoris by the Canadian Cardiovascular Society classification system, the differential diagnosis of chest pain, conditions promoting myocardial oxygen supply and demand mismatch, the features of typical angina, the classification of chest pain, a comparison of the pretest likelihood of coronary heart disease (CHD) in low-risk and high-risk symptomatic patients, the posttest probability of significant CHD based on pretest probabilities of CHD and normal or abnormal results of noninvasive studies, survival according to risk groups based on Duke treadmill scores, high- and moderate-intensity statin therapy, revascularization to improve survival compared with medical therapy, revascularization to improve symptoms with significant anatomic (≥ 50% left main or ≥ 70% nonleft main coronary artery disease) or physiologic (fractional flow reserve ≤ 0.80) coronary artery stenoses, and questions recommended by an expert panel for patients with chronic stable angina at follow-up visits. This review contains 7 highly rendered figures, 13 tables, and 109 references.

Chronic Stable Angina

2018 ◽  
Author(s):  
Benjamin J Scirica ◽  
J. Antonio T. Gutierrez
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Heart Disease ◽  
Percutaneous Coronary Intervention ◽  
Heart Disease ◽  
Coronary Artery ◽  
Stable Angina ◽  
Chronic Stable Angina ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
Artery Disease

By definition, chronic stable angina is angina that has been stable with regard to frequency and severity for at least 2 months. Chronic stable angina is the initial manifestation of coronary heart disease in approximately 50% of patients. Typically, this type of angina occurs in the setting of atherosclerotic coronary arterial narrowing, although other causes are possible. This review covers the epidemiology, pathophysiology, initial evaluation, differential diagnosis, management, and treatment of patients with chronic stable angina. Figures show noninvasive testing and the probability of coronary artery disease; diagnosis of patients with suspected ischemic heart disease; probability of severe coronary artery disease; coronary outcomes for high- versus low-intensity statin therapy; optimal medical therapy (OMT) versus OMT and percutaneous coronary intervention for chronic angina; OMT versus percutaneous coronary intervention for stable coronary heart disease; and coronary artery bypass grafting versus percutaneous coronary intervention for diabetes and coronary artery disease. Tables list the grading of angina pectoris by the Canadian Cardiovascular Society classification system, the differential diagnosis of chest pain, conditions promoting myocardial oxygen supply and demand mismatch, the features of typical angina, the classification of chest pain, a comparison of the pretest likelihood of coronary heart disease (CHD) in low-risk and high-risk symptomatic patients, the posttest probability of significant CHD based on pretest probabilities of CHD and normal or abnormal results of noninvasive studies, survival according to risk groups based on Duke treadmill scores, high- and moderate-intensity statin therapy, revascularization to improve survival compared with medical therapy, revascularization to improve symptoms with significant anatomic (≥ 50% left main or ≥ 70% nonleft main coronary artery disease) or physiologic (fractional flow reserve ≤ 0.80) coronary artery stenoses, and questions recommended by an expert panel for patients with chronic stable angina at follow-up visits. This review contains 7 highly rendered figures, 13 tables, and 109 references.

scholarly journals Clinical efficiency of restorative treatment after percutaneous coronary intervention in patients with coronary artery disease

2021 ◽  
Vol 17 (1) ◽  
pp. 133-137
Author(s):  
Nodir Kayumov Ulug’bekovich ◽  
Djamshid Payziev Djuravaevich ◽  
Orziev Daler Zavkiddinovich
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Heart Disease ◽  
Lipid Metabolism ◽  
Coronary Artery ◽  
Platelet Aggregation ◽  
Coronary Intervention ◽  
Restorative Treatment ◽  
Percutaneous Coronary ◽  
Artery Disease

The article discusses topical issues of treatment and rehabilitation strategies in patients with ischemic heart disease (IHD). The results of our own research on assessing the effectiveness of complex rehabilitation of patients with myocardial changes with the study of indicators of lipid metabolism, platelet aggregation, functional state of patients with coronary artery disease, after stenting of the coronary arteries have been stated in the article.

Stable Ischemic Heart Disease: Medical Therapy With or Without Revascularization

2019 ◽  
Author(s):  
Ashish Sarraju ◽  
David J Maron
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Heart Disease ◽  
Coronary Artery ◽  
Medical Therapy ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Bypass Grafting ◽  
Percutaneous Coronary ◽  
Artery Disease

Coronary artery disease (CAD) poses a significant global public health burden. Patients with CAD who do not present with acute coronary syndromes are considered to have stable ischemic heart disease (SIHD). Options for the management of SIHD are medical therapy including pharmacologic therapy and lifestyle modification and revascularization with either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Guideline-directed medical therapy is recommended for all patients with SIHD. Aside from severe stenosis in an unprotected left main coronary artery, the role of routine revascularization in the management of SIHD is unclear. Early CABG trials from the 1970s and 1980s demonstrated prognostic benefit with CABG versus medical therapy, but these results have limited applicability in the setting of modern medical therapy, including the widespread use of statins and aspirin and intensive lifestyle interventions. Contemporary strategy trials examining PCI plus medical therapy versus medical therapy alone have not demonstrated prognostic benefit with the addition of PCI. The addition of revascularization offers consistent symptom and quality-of-life benefit compared with medical therapy alone based on trial data, though this benefit may be time limited with PCI. Thus, there is a state of equipoise regarding the addition of revascularization to guideline-directed medical therapy in the management of SIHD. Therefore, shared decision-making is key when determining the best management strategy for a patient with SIHD and should include discussion of expected risks and benefits based on high-quality evidence, costs, and patient preferences. This review contains 6 figures, 8 tables, and 55 references.  Key Words: angina, antianginal therapy, coronary artery disease, coronary artery bypass grafting, guideline-directed medical therapy, ischemia, optimal medical therapy, percutaneous coronary intervention, revascularization

scholarly journals ADMINISTRATION OF LOADING DOSES OF STATINS FOR PREVENTION OF CONTRAST-INDUCED KIDNEY INJURY DURING ENDOVASCULAR INTERVENTIONS IN PATIENTS WITH ISCHEMIC HEART DISEASE

2019 ◽  
Vol 33 (4) ◽  
pp. 111-118 ◽  
Author(s):  
O. E. Shalaeva ◽  
E. O. Vershinina ◽  
A. N. Repin
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Heart Disease ◽  
Coronary Artery ◽  
Myocardial Revascularization ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Loading Dose ◽  
Percutaneous Coronary ◽  
Artery Disease

Percutaneous coronary interventions have become a key method of revascularization in patients with coronary artery disease. Contrast-induced nephropathy is one of the main complications in patients who undergo coronary angiography and percutaneous coronary intervention. Loading doses of statins are often used for the purpose of nephroprotection. However, a clear available algorithm for prescribing statins for the prevention of acute contrast-induced kidney injury has not been identified. The purpose: to evaluate the effectiveness of high loading doses of statins (atorvastatin and rosuvastatin) to prevent acute contrast-induced kidney injury in patients with chronic ischemic heart disease during planned endovascular treatment.Material and Methods. Patients with clinical manifestations of FC II and III angina pectoris and hemodynamically significant stenoses of the coronary arteries were referred for a planned endovascular myocardial revascularization. Two groups of patients were assigned based on the intake of synthetic statins: atorvastatin and rosuvastatin. Before the endovascular intervention, patients were administered with high loading doses of statins. All patients underwent general clinical examination, routine assessment of creatinine levels, other blood tests, assessment of glomerular filtration rate, and control of lipid profile of blood.Conclusion. The incidence rate of contrast-induced kidney injury in patients with coronary artery disease, administered with loading doses of rosuvastatin, in the course of planned percutaneous coronary intervention was lower compared with the loading therapy of atorvastatin: 3.33 and 12.12%, respectively. On average, an increase in creatinine concentration to the maximum level occurred more often in the group of patients administered with a loading dose of atorvastatin than in the other group administered with a loading dose of rosuvastatin (14.3 versus 8.1%, p=0.024). A decrease in renal function in terms of GFR of less than 60 mL/min/1.73 m2 on day 5 was observed in 12 patients (34.3%) in the first group versus 9 patients (27.3%) in the second group. Therapy with loading doses of rosuvastatin before endovascular myocardial revascularization was more effective than treatment of patients with atorvastatin. 

Genetic predictors for symptoms recurrenсe in coronary artery disease after percutaneous coronary intervention

2017 ◽  
pp. 81-86
Author(s):  
Г.А. Березовская ◽  
Е.С. Клокова ◽  
Н.Н. Петрищев
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
Folate Metabolism ◽  
Genotype Distribution ◽  
Polymorphic Markers ◽  
Percutaneous Coronary ◽  
Artery Disease

Гены тромбообразования и фолатного обмена играют важную роль в развитии и прогрессии ишемической болезни сердца (ИБС). Однако о возможной роли полиморфных маркеров в рецидиве ИБС после чрескожного коронарного вмешательства (ЧКВ) известно недостаточно. Цель исследования: Оценить роль генетических факторов системы тромбообразования и фолатного обмена (полиморфных маркеров генов F5, F2, F13A1, PAI1, HPA1, MTHFR, FGB ), в возобновление клиники ИБС после ЧКВ. Методика: Исследование проводили с использованием выборки из 90 больных ИБС в возрасте от 40 до 75 лет: 75 пациентов после планового ЧКВ (60 мужчин и 15 женщин) и 15 лиц после экстренного ЧКВ (12 мужчин и 3 женщины). Молекулярно-генетическое исследование было выполнено с помощью комплекта реагентов «Сердечно-сосудистые заболевания СтрипМетод»® (ViennaLab Diagnostics GmbH, Австрия), выявляющие следующие варианты: F5, F2, F13A1, PAI1, HPA1, MTHFR, FGB . Результаты: В результате исследования была показана ассоциация полиморфного маркера G103T ( Val34Leu ) гена F13A1 (фактор свертываемости крови 13, субъединица A1) с развитием рецидивирующего состояния ИБС после ЧКВ. Выявлены статистически значимые различия в распределении частот генотипов полиморфного маркера Val34Leu гена F13A1 . Показано, что частота генотипа Val/Val у пациентов с осложнениями была выше, чем у пациентов без таковых: 0,700 и 0,400 соответственно (c = 7,78; p = 0,020), при этом генотип Val/Val проявил себя как фактор риска развития осложнений: ОШ = 3,50 (95%ДИ 1,37-8,93). При сравнении аллелей выявили, что частота аллеля L у больных с осложнениями была ниже, чем у лиц без таковых: 0,167 и 0,375 соответственно (p = 0,004), и носительство аллеля L уменьшало вероятность развития осложнений: ОШ = 0,33 (95%ДИ 0,15-0,72). Заключение: Носительство варианта 34V гена F13A1 , кодирующего A-субъединицу фактора свёртывания 13, предрасполагает к возобновлению клинических проявлений ИБС после ЧКВ. Genes of thrombosis and folate metabolism play an important role in development and progression of coronary artery disease (CAD). However, a possible role of polymorphic markers in CAD relapse following percutaneous coronary intervention (PCI) is not sufficiently understood. Background. Reports have indicated an association of genetic factors generally related with thrombophilia and recurrence of symptoms for coronary artery disease (CAD) following a percutaneous coronary intervention (PCI) due to restenosis and in-stent thrombosis. However, the relapse can also be caused by progression of atherosclerosis and endothelial dysfunction in unoperated blood vessels. Aim: To assess the role of genetic risk factors involved in thrombosis and folate metabolism (polymorphic markers of F5, F2, F13A1, PAI1, HPA1, MTHFR, and FGB genes) in recurrence of CAD symptoms after PCI. Methods: The study included 90 patients with CAD aged 40-75; 75 of these patients had undergone elective PCI (60 men and 15 women) and 15 patients - emergency PCI (12 men and 3 women). Molecular genetic tests were performed using a CVD StripAssays® reagent kit (ViennaLab Diagnostics GmbH, Austria) to identify the following genetic variations: F5, F2, F13A1, PAI1, HPA1, MTHFR, and FGB . Results: The study results showed a significant association of the G103T ( Val34Leu ) polymorphism in the F13A1 gene with relapses of IHD after PCI. Significant differences were found in genotype distribution frequencies of the Val34Leu polymorphism in the F13A1 gene. The frequency of Val / Val genotype was higher in patients with complications than without complications, 0.700 and 0.400, respectively (c = 7.78, p = 0.020). Furthermore, the Val/Val genotype can be classified as a risk factor for complications (OR = 3.50; 95% CI, 1.37-8.93). The L allele frequency was lower in patients with complications than in those without complications (0.167 and 0.375, respectively, p = 0.004), and carriage of the L allele reduced the likelihood of complications (OR = 0.33; 95% CI 0.15-0.72). Conclusion: Carriage of the 34V variant in the F13A1 gene that encodes the coagulation factor XIII A subunit predisposes to a relapse of CAD symptoms after PCI.

Sign in / Sign up

Export Citation Format

Share Document