《慢性稳定型心绞痛指南》介绍

慢性稳定型心绞痛是冠心病（CHD）的一个经典类型，指活动和（或）情绪激动后反复出现可预测的左前胸部（心前区）不适，症状通常在天气寒冷或餐后加重，而在休息时或舌下含服硝酸甘油后缓解。上述症状是完全可逆性，在几个月到几年内反复发作，有别于出现新的症状、症状持续时间延长、新近发生症状的不稳定型心绞痛。

Prognostic value of coronary artery calcium score in patients with stable an-gina pectoris after percutaneous coronary intervention

Objectives To evaluate the prognostic value of the coronary artery calcium （CAC） score in patients with stable angina pectoris （SAP） who underwent percutaneous coronary intervention （PCI）. Methods A total of 334 consecutive patients with SAP who underwent first PCI following multi-slice computer tomography （MSCT） were enrolled from our institution between January 2007 and June 2012. The CAC score was calculated according to the standard Agatston calcium scoring algorithm. Complex PCI was defined as use of high pressure bal-loon, kissing balloon and/or rotablator. Procedure-related complications included dissection, occlusion, perforation, no/slow flow and emer-gency coronary artery bypass grafting. Main adverse cardiac events （MACE） were defined as a combined end point of death, non-fatal myo-cardial infarction, target lesion revascularization and rehospitalization for cardiac ischemic events. Results Patients with a CAC score〉300 （n=145） had significantly higher PCI complexity （13.1%vs. 5.8%, P=0.017） and rate of procedure-related complications （17.2%vs. 7.4%, P=0.005） than patients with a CAC score≤300 （n=189）. After a median follow-up of 22.5 months （4-72 months）, patients with a CAC score≤300 differ greatly than those patients with CAC score＆gt;300 in cumulative non-events survival rates （88.9 vs. 79.0%, Log rank 4.577, P=0.032）. After adjusted for other factors, the risk of MACE was significantly higher [hazard ratio （HR）：4.3, 95%confidence inter-val （95%CI）：2.4-8.2, P=0.038] in patients with a CAC score〉300 compared to patients with a lower CAC score. Conclusions The CAC score is an independent predictor for MACE in SAP patients who underwent PCI and indicates complexity of PCI and proce-dure-related complications.

Coronary revascularization in the elderly with stable angina

A proportion of elderly with coronary artery disease is rapidly growing. They have more severe coronary artery disease, therefore, derive more benefit fi＇om revascularization and have a greater need for it. The elderly is a heterogeneous group, but compared to the younger cohort, the choice of the optimal revascularization method is much more complicated among them. In recent decades, results has improved dramatically both in surgery and percutaneous coronary intervention （PCI）, even in very old persons. Despite the lack of evidence in elderly, it is obvious, that coronary artery bypass surgery （CABG） has a more pronounced effect on long-term survival in price of more strokes, while PCI is certainly less invasive. Age itself is not a criterion for the selection of treatment strategy, but the elderly are often more interested in quality of life and personal independence instead of longevity. This article discusses the factors that influence the choice of the revascularization method in the elderly with stable angina and presents a complex algorithm for making an individual risk-benefit profile. As a consequence the features of CABG and PCI in elderly patients are exposed. Emphasis is centered on the frailty and non-medical factors, including psychosocial, as essential components in making the decision of what strategy to choose. Good communication with the patients and giving them unbiased information is encouraged.

Core outcome set for stable angina pectoris in traditional Chinese medicine(COS-SAP-TCM)

Objective:This study aimed to develop a core outcome set(COS)for use in future studies of stable angina pectoris(SAP)in traditional Chinese medicine(TCM).Methods:Systematic literature reviews and qualitative interviews with cardiologists and patients with SAP treated using TCM were conducted to generate a set of outcomes.Outcomes were prioritized by stakeholders via two rounds of an online Delphi survey and face-to-face consensus meetings.Following the final consensus meeting,a final COS was generated.Results:An initial set of 324 outcomes was identified.A preliminary list of 65 outcomes was employed in the Delphi study.In total,223 participants from seven stakeholder groups were invited to score outcomes in the first Delphi round:87 completed round 1 and 47 completed round 2.Thirty-one participants attended the consensus meeting and agreed on a final core set of outcomes comprising six items across four domains:frequency of angina attack,duration of angina attack,Seattle angina questionnaire,total exercise duration in the exercise treadmill test,cardiovascular events,and QT interval on electrocardiography.Conclusions:The COS developed in this study provides the minimum requirements for measurement and reporting in future TCM clinical trials for the treatment of SAP.The employment of this COS may reduce heterogeneity across trials and facilitate evidencebased decision-making for stakeholders.

Is the ratio of apoB/apoA-1 the best predictor for the severity of coronary artery lesions in Chinese diabetics with stable angina pectoris？ An assessment based on Gensini scores

Background There is a paucity of data about the best lipid ratio predicting the severity of coronary artery disease （CAD） in patients with diabetes mellitus. We determined the relationship between five conventional lipid ratios and the extent of coronary artery lesions in Chinese Type 2 diabetics with stable angina pectoris （SAP）. Methods A prospective cohort study within 373 type 2 diabetic patients diag- nosed with stable CAD by coronary angiography was performed. All patients were classified into three groups according to the tertiles of Gensini scores （GS, low group 〈 8 points n = 143; intermediate group 8-28 points, n = 109; high group 〉 28 points, n = 121）. Association between the ratios of apolipoprotein （apo） B and apoA-1, total cholesterol and high density lipoprotein cholesterol （TC/HDL-C）, triglycerides and HDL-C （TG/HDL-C）, low density lipoprotein cholesterol and HDL-C （LDL-C/HDL-C）, Non-HDL-C/HDL-C and GS were evaluated using the receivers operating characteristic （ROC） curves and multivariate logistic regression models. Results The ratio of apoB/apoA-1, TC/HDL-C, LDL-C/HDL-C, and Non-HDL-C/HDL-C were correlated with Gensini scores. Area under the ROC curves for predicting high Gensini scores in the ratios of apoB/apoA-1, TC/HDL-C, LDL-C/HDL-C and Non-HDL-C/HDL-C were 0.62, 0.60, 0.59 and 0.60, respec- tively （P 〈 0.005 for all）. According to multivariate logistic regression analysis after adjusted with demographic characteristic and other lipid parameters, the ratio of apoB/apoA-1 is qualified as an independent discriminator for the severity of CAD. However, after fiu-ther adjusting different baseline variables, such as left ventricular ejective fraction, hemoglobin Alc, leukocytes count and serum creatinine, none of the above lipid ratios remained. Conclusions Compared with other lipid parameters, the ratio of apoB/apoA-1 appears to be more significantly correlated with the extent of coronary artery lesions in Chinese diabetics, but it was not an independent predictor in these settings.

Concomitant acute myocardial infarction and descending thoracic aorta penetrating ulcer

Acute coronary syndrome （ACS） refers to a spectrum of clinical presentations ranging from unstable angina to non-ST-segment elevation myocardial infarction （NSTEMI） to ST-segment elevation myocardial infarction （STEMI）. Aortic dissection, intramural hematoma and penetrating atherosclerotic ulcer （PAU） are three major acute aortic syndromes （AAS）.

Role of Dongchongxiacao (Cordyceps) in prevention of contrast-induced nephropathy in patients with stable angina pectoris

OBJECTIVE： To study the preventative effects of Dongchongxiacao （Cordyceps） on contrast-induced nephropathy （CIN） in patients with stable angina pectoris （SAP）. METHODS： One-hundred and three SAP inpatients were divided randomly into two groups： basic treat- ment （n=51） and Dongchongxiacao （Cordyceps） treatment （n=52）; corbrin capsules （3 g; t.d.s.） were used 3 days before angioplasty and 3 days after an- gioplasty）. Serum creatinine （Scr） was assessed at the time of hospital admission and 1, 2, and 3 days after angioplasty. Values of kidney injury mole- cule-1 （KIM-1）, neutrophil gelatinase-associated li- pocalin （NGAL） and interleukin （IL） 18 in the kidney were detected before angioplasty and 1 day after angioplasty in the patients of both groups. The prevalence of CIN between the two groups was then compared. RESULTS： CIN occurred in 9 of 103 patients （8.74%）. The prevalence of CIN in the Dongchongxiacao （Cordyceps） treatment group was lower than that of the basic treatment group （5.77% vs 11.76%） but the difference was not significant （P〉0.05）. The post-procedure mean peak of Scr, post-procedure increase in Scr levels from baseline, and urine levelsof KIM-1, NGAL and IL18 after the procedure in the Dongchongxiacao （Corclyceps） treatment group were significantly lower than those in the basic treatment group （P〈0.05）. CONCLUSION： Prophylactic treatment with Dongchongxiacao （Cordyceps） in SAP patients who undergo coronary angiography or coronary inter- vention could prevent contrast-induced renal im- pairment.

Danshenchuanxiongqin injection in the treatment of unstable angina pectoris: a systematic review and Meta-analysis

OBJECTIVE:To evaluate systematically the efficacy and safety of Danshenchuanxiongqin Injection(DCI)in the treatment of unstable angina pectoris(UAP).METHODS:Randomized controlled trials(RCTs)regarding DCI used for treating UAP were searched in English and Chinese electronic databases from inception to January 2014.Two reviewers independently retrieved RCTs and extracted relevant information.The Cochrane risk of bias method was used to assess the quality of included studies,and a Meta-analysis was conducted with Review Manager5.2 software.RESULTS:Eleven RCTs involving 1034 participants were included.The methodological quality was relatively passable.The Meta-analysis indicated that the combined use of DCI and conventional treatment with Western Medicine(WM)was more efficacious in the outcomes of total effective rate[Relative Risk(RR)=1.27,95%CI(confidence interval;1.18,1.35),P<0.000 01],the total effective rate of ECG[RR=1.40,95%CI(1.18,1.66),P<0.000 01],total cholesterol[Mean difference(MD)=-0.58,95%CI(-0.83,-0.33),P<0.000 01],total triglycerides[MD=-0.36,95%CI(-0.54,-0.17),P=0.0001],and the number of ST-segment depression[MD=-0.36,95%CI(-0.54,-0.17),P=0.0001].There were two adverse drug reactions reported in one study.CONCLUSION:Based on the systematic review,DCI combined with WM appeared to be efficacious in the treatment UAP.However,the evidence of DCI for treating UAP requires large-scale and double-blind RCTs to substantiate these findings.

Rules of acupoint and meridian selection in acupuncture-moxibustion for stable angina pectoris

To summarize and analyze the acupoint selection rules in acupuncture-moxibustion for stable angina pectoris. Clinical studies and literature on acupuncture-moxibustion for stable angina pectoris with definite acupoint selection were included through retrieving China National Knowledge Infrastructure（CNKI）,Wanfang Database and VIP in order to analyze the characteristics and rules of acupoint selection in acupuncture-moxibustion treatment for stable angina pectoris. It has been found that the acupoint selection of acupuncture-moxibustion prescriptions for stable angina pectoris focused on specific acupoints.The top 5 acupoints with the highest using frequency included Neiguan（内关PC 6）,Danzhdng（膻中CV17）,Xinshu（心俞BL 15）,Ziusanli（足三里ST 36） and Sanyinjiao（三阴交SP 6）. Acupuncture-moxibustion treatment of stable angina pectoris involved 12 meridians, mainly including the hand-jueyin pericardium meridian, the foot-taiyang bladder meridian, conception vessel, the foot-yangming stomach meridian, the foot-taiyin spleen meridian, and the hand-shaoyin heart meridian, etc., embodying the characteristics and rules of acupoint selection such as ＂highlighting the special treatment effect of acupoints＂ ＂selecting acupoints along the pericardium meridian, bladder meridian and conception vessel, combining the anterior and the posterior acupoints＂, ＂selecting the distal acupoints of spleen and stomach meridians, and focusing on specific acupoints＂, etc.

Needle-embedding therapy combined with basic treatment for stable angina pectoris

Objective： To clarify the clinical efficacy of needle-embedding therapy for stable angina pectoris. Methods： Seventy-six patients with stable angina pectoris were divided into needle-embedding therapy group （group A） and basic treatment group （group B） according to the random number table, with 38 patients in each group. Needle-embedding therapy combined with basic treatment was adopted in group A, and needle-embedding was given once every other day, the needles were retained for 24 h each time and three times of treatment were given each week. basic treatment was applied solely in group B. Four weeks of treatment which means one course were given in two groups, efficacy observation and evaluation were carried out after 1 course of treatment. Results： After treatment, the total effective rate of clinical efficacy was 89.47% in group A and 71.05% in group B （p 〈 0.05）, and the total effective rate of electrocardiograph （ECG） efficacy was 84.21% in group A and 63.16% in group B （p〈0.05）. After treatment, the score of limitation of motion, score of the sta- ble state of angina pectoris and the score of angina pectoris attack in group A increased by 0.7%, 34,5% and 16.9% respectively when compared with the scores before treatment （t= 1.623, p 〈0.0l; t=3.867, p 〈 0.01 ; t = 1.958, p 〈 0.05）, and according to the comparison of the score of satisfaction with treatment and the score of disease perception before and after treatment, the difference was not statistically significant （t=4.972, p 〉 0.05; t=0.999, p 〉 0.05）. According to the comparison of the score of limitation of motion, score of angina pectoris attack, score of satisfaction with treatment and the score of disease per- ception in group B before and after treatment, the differences were not statistically significant （t = 1.726, p 〉 0.05; t = 1.594, p 〉 0.05; t = 4.385, p 〉 0.05; t = 0.999, p 〉 0.05）. The score of： the stable state of angina pectoris increased by 4.9% （t = 1.780, p 〈 0.05）. Conclusion： Needle-embedding in acupoint therapy can effectively improve the clinical efficacy, ECG efficacy and the score of Seattle angina questionnaire （SAQ） of stable angina pectoris.

Safflower yellow injection combined with conventional therapy in treating unstable angina pectoris:a meta-analysis

OBJECTIVE： To evaluate the clinical efficacy of safflower yellow injection combined with conventional therapy in treating unstable angina pectoris.METHODS： We searched online databases： Chinese journal full-text database, China National Knowledge Infrastructure, Wanfang database, Chinese journal full-text database, Pubmed, ScienceDirect,Embase, and the Cochrane Library with manual-screening of relevant literature. Eligible randomized controlled trials（RCT） on angina pectoris were included. We conducted meta-analysis using the RevMan 5.1 software from The Cochrane Collaboration. We treated the relief rate of angina symptoms and electrocardiograph（ECG） as evaluation.RESULTS： Seven articles, including in 1134 patients, were enrolled after the evaluation. Therewas no significant heterogeneity among the studies（χ2=1.08, df=6, P=0.98, I2=0%）. The safflower yellow injection with conventional therapy has a higher effective rate than the control group in relieving the symptoms of angina pectoris [odds ratio（OR）=2.95, 95%（CI）（1.81, 4.81）] and improving ischemic ECG [OR=2.85, 95% CI（1.67, 4.86）]. The difference was statistically significant in the ＂80 mg dosage＂ and ＂100 mg dosage＂ subgroups（P0.05） for improving clinical symptoms and ECG. The funnel graphic was nearly symmetrical. Sensitivity analysis suggested that the results were stable.CONCLUSION： Safflower yellow injection as an adjunct therapy with conventional drugs shows advantages in easing the clinical symptoms of unstable angina and improving ECG over basic therapy alone. However, the conclusions should be interpreted with care until more high-quality RCTs are reported.

Logistic Regression Analysis of Syndrome Essential Factors in Patients with Unstable Angina Pectoris

Objective: To explore the correlation between common syndrome essential factors and the symptoms and signs of unstable angina (UA). Methods: Eight hundred and fifteen patients with UA confirmed by coronary angiography were identified from several centers. Common syndrome essential factors were selected on the basis of expert experience. The correlations between common syndrome essential factors and symptoms and signs of UA were analyzed using binary logistic regression analysis. Results: The common syndrome essential factors in unstable angina were blood stasis, qi stagnation, phlegm turbidity, heat stagnancy, qi deficiency, yin deficiency, and yang deficiency. Symptoms such as chest pain, hypochondriac distention, ecchymosis, dark orbits, dark and purplish tongue, and tongue with ecchymosis and petechiae were significant diagnostic features of "blood stasis". Aversion to cold and cool limbs, weakness in the waist and knees, and clear abundant urine were significant diagnostic features of "yang deficiency". These results were in accordance with the understanding of traditional clinical Chinese medical practice. Conclusion: This clinical study analyzed the correlations between common syndrome essential factors and the symptoms and signs of unstable angina. The results provide the basis for establishing diagnostic criteria for syndrome essential factors.