Главной целью лечения хронической ишемической болезни сердца (ИБС) является снижение риска развития осложнений, в первую очередь инфаркта миокарда, и смертности (увеличение продолжительности жизни) при обеспечении хорошего качества жизни. В последнее время появились новые возможности в лечении ИБС: увеличение продолжительности применения двойной антиагрегантной терапии и более интенсивное снижение уровня холестерина липопротеидов низкой плотности с помощью комбинированной терапии, новые схемы антиангинальной терапии и некоторые другие. Уточнены позиции инвазивного лечения, включая соотношение между эндоваскулярным лечением и коронарным шунтированием. Современная многокомпонентная стратегия ведения больного с хронической ИБС позволяет добиваться не только улучшения качества жизни, но и увеличения продолжительности жизни, в том числе без сердечно-сосудистых осложнений.
The main aim of chronic ischemic heart disease (IHD) treatment is to reduce the risk of complications – especially a myocardial infarction, and mortality (to increase life expectancy) in providing a good quality of life. New treatment options for IHD have been worked out recently: the increase of duration of dual antiplatelet therapy and intensive lowering of low-density lipoprotein cholesterol levels as a part of combined therapy, new schemes of antianginal therapy and some others. The characteristics of invasive treatment, including the correlation between endovascular treatment and coronary artery bypass graft surgery, have been outlined. Modern multi-component strategy using for management of patients with chronic IHD allows us to improve not only the quality of life, but also to increase life expectancy, without cardiovascular complications.
1. 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.
2. Рациональная фармакотерапия сердечно-сосудистых заболеваний. Под ред. Е.И.Чазова, Ю.А.Карпова. М.: Литтерра, 2014; c. 28–36. / Ratsional'naia farmakoterapiia serdechno-sosudistykh zabolevanii. Pod red. E.I.Chazova, Iu.A.Karpova. M.: Litterra, 2014; c. 28–36. [in Russian]
3. Bonaca MP, Bhatt DL, Cohen M et al. PEGASUS-TIMI 54 Steering Committee and Investigators. Long-term use of ticagrelor in patients with prior myocardial infarction. N Engl Med 2015; 372: 1791–800.
4. Mauri L, Kereiakes K, Jeh RW et al. The DAPT Investigators. Twelve or 30 months of dual antiplatelet terapy after drug-eluting stents. N Engl J Med 2014; 371: 1016–27.
5. Fihn SD, Blankenship JC, Alexander KP et al. 2014 ACC/AHA/AATS/PCNA/ SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease. Circulation 2014; 130: 1749–67.
6. Cannon CP, Blazing MA, Giugliano RP et al. IMPROVE-IT Investigators. Ezetimibe added to statin therapy after acute coronary syndromes. N Engl J Med 2015; 372: 2387–97.
7. Kinoshita M, Sakai K. Pharmacology and Therapeutic Effects of Nicorandil. Cardiovasc Drugs Ther 1990; 4: 1075–88.
8. Meany TB, Richardson P, Camm AJ et al. Exercise capacity after single and twice-daily doses of nicorandil in chronic stable angina pectoris. Am J Cardiol 1989; 63: 66–70.
9. Yang J, Zhang J, Cui W et al. Cardioprotective effects of single oral dose of nicorandil before selective percutaneous coronary intervention. Anadolu Kardiyol Derg 2015; 15 (2): 125–31.
10. Airaksinen KE, Huikuri HV. Antiarrhythmic effect of repeated coronary occlusion during balloon angioplasty. J Am Coll Cardiol 1997; 29 (5): 1035.
11. Sakamoto T, Kaikita K, Miyamoto S et al. Effects of nicorandil on endogenous fibrinolytic capacity in patients with coronary artery disease. Circ J 2004; 68: 232–56.
12. Izumiya Y, Kojima S, Araki S et al. Long-term use of oral nicorandil stabilizes coronary plaque in patients with stable angina pectoris. Atherosclerosis 2011; 214 (2): 415–21.
13. Markham A, Plosker GL, Goa KL. Nicorandil. An updated review of its use in ischaemic heart disease with emphasis on its cardio-protective effects. Drugs 2000; 60: 955–74.
14. Sekiya M, Sato M, Funada J et al. Effects of the long-term administration of nicorandil on vascular endothelial function and the progression of arteriosclerosis. J Cardiovasc Pharmacol 2005; 46 (1): 63–7.
15. Kasama S, Toyama T, Sumino H et al. Long-term nicorandil therapy improves cardiac sympathetic nerve activity after reperfusion therapy in patients with first acute myocardial infarction. J Nucl Med 2007; 48 (10): 1676–82.
16. Kasama S, Toyama T, Hatori T et al. Comparative effects of nicorandil with isosorbide mononitrate on cardiac sympathetic nerve activity and left ventricular function in patients with ischemic cardiomyopathy. Am Heart J 2005; 150 (3): 477.e1–477.e8.
17. The IONA Study Group. Effect of nicorandil on coronary events in patients with stable angina: the Impact Of Nicorandil in Angina (IONA) randomised trial. Lancet 2002; 359: 1269–75.
18. The IONA Study Group. Impact of nicorandil in angina: subgroup analyses. Heart 2004; 90: 1427–30.
19. Horinaka S, Yabe A, Yagi H et al. Effects of nicorandil on cardiovascular events in patients with coronary artery disease in the Japanese Coronary Artery Disease (JCAD) study. Circ J 2010; 74 (3): 503–9.
20. Sakata Y, Nakatani D, Shimizu M et al. Oral treatment with nicorandil at discharge is associated with reduced mortality after acute myocardial infarction. J Cardiol 2012; 59 (1): 14–21.
21. Булахова Е.Ю., Кореннова О.Ю., Кондрашева М.Н. и др. Клинические преимущества терапии никорандилом по сравнению с изосорбид-5-мононитратом у больных ИБС. Сердце. 2013; 12, №2 (70): 83–7. / Bulakhova E.Iu., Korennova O.Iu., Kondrasheva M.N. i dr. Klinicheskie preimushchestva terapii nikorandilom po sravneniiu s izosorbid-5-mononitratom u bol'nykh IBS. Serdtse. 2013; 12, №2 (70): 83–7. [in Russian]
22. Резванова Ю.А., Адамчик А.С. Оценка антиишемической и кардиопротективной эффективности никорандила у пациентов со стабильной стенокардией. Кардиология. 2015 8 (55): 21–5. / Rezvanova Iu.A., Adamchik A.S. Otsenka antiishemicheskoi i kardioprotektivnoi effektivnosti nikorandila u patsientov so stabil'noi stenokardiei. Kardiologiia. 2015 8 (55): 21–5. [in Russian]
23. Рябихин Е.А., Можейко М.Е., Красильникова Ю.А. и др. Дополнительные возможности в лечении ишемической болезни сердца, осложненной хронической сердечной недостаточностью с низкой фракцией выброса левого желудочка. Сердечная недостаточность. 2016; 17 (1): 3–9. / Riabikhin E.A., Mozheiko M.E., Krasil'nikova Iu.A. i dr. Dopolnitel'nye vozmozhnosti v lechenii ishemicheskoi bolezni serdtsa, oslozhnennoi khronicheskoi serdechnoi nedostatochnost'iu s nizkoi fraktsiei vybrosa levogo zheludochka. Serdechnaia nedostatochnost'. 2016; 17 (1): 3–9. [in Russian]
24. Weisz G, Généreux P, Iñiguez A et al. for the RIVER-PCI investigators. Ranolazine in patients with incomplete revascularisation after percutaneous coronary intervention (RIVER-PCI): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet 2016; 387: 136–45.
25. Alexander KA, Weisz G, Prather K et al. Effects of Ranolazine on Angina and Quality of Life After Percutaneous Coronary Intervention With Incomplete Revascularization Results From the Ranolazine for Incomplete Vessel Revascularization (RIVER-PCI) Trial. Circulation 2016; 133: 39–47.
26. Takahashi J et al. Prognostic impact of chronic nitrate therapy in patients with vasospastic angina: multicentre registry study of the Japanese coronary spasm association. Eur Heart J 2015; 36: 228–37. Doi:10.1093/eurheartj/ehu313.
27. Boden WE, O’Rourke RA, Teo KK et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 2007; 356: 1503–16.
28. Sedlis SP, Hartigan PM, Teo KK et al. For the COURAGE Trial Investigators. Original Effect of PCI on Long-Term Survival in Patients with Stable Ischemic Heart Disease. N Engl J Med 2015; 373: 1937–46.
29. 2014 ESC/EACTS Guidelines on myocardial revascularization. The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2014. Doi: 10.1093/eurheartj/ehu278.
30. Kiramijyan S, Liu MW. The benefits of drug-eluting stents in the treatment of coronary artery disease. Res Rep Clin Cardiol 2016; 7: 9–25.
31. Bangalore S, Toklu B, Feit F. Outcomes with coronary artery bypass graft surgery versus percutaneous coronary intervention for patients with diabetes mellitus: can newer generation drug-eluting stents bridge the gap? Circ Cardiovasc Interv 2014; 7 (4): 518–25.
32. Campos CM, Christiansen EH, Stone GW, Serruys PW. The EXCEL and NOBLE trials: similarities, contrasts and future perspectives for left main revascularisation. Euro Intervention 2015; 11 (Suppl. V): V115–V119.
________________________________________________
1. 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.
2. Ratsional'naia farmakoterapiia serdechno-sosudistykh zabolevanii. Pod red. E.I.Chazova, Iu.A.Karpova. M.: Litterra, 2014; c. 28–36. [in Russian]
3. Bonaca MP, Bhatt DL, Cohen M et al. PEGASUS-TIMI 54 Steering Committee and Investigators. Long-term use of ticagrelor in patients with prior myocardial infarction. N Engl Med 2015; 372: 1791–800.
4. Mauri L, Kereiakes K, Jeh RW et al. The DAPT Investigators. Twelve or 30 months of dual antiplatelet terapy after drug-eluting stents. N Engl J Med 2014; 371: 1016–27.
5. Fihn SD, Blankenship JC, Alexander KP et al. 2014 ACC/AHA/AATS/PCNA/ SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease. Circulation 2014; 130: 1749–67.
6. Cannon CP, Blazing MA, Giugliano RP et al. IMPROVE-IT Investigators. Ezetimibe added to statin therapy after acute coronary syndromes. N Engl J Med 2015; 372: 2387–97.
7. Kinoshita M, Sakai K. Pharmacology and Therapeutic Effects of Nicorandil. Cardiovasc Drugs Ther 1990; 4: 1075–88.
8. Meany TB, Richardson P, Camm AJ et al. Exercise capacity after single and twice-daily doses of nicorandil in chronic stable angina pectoris. Am J Cardiol 1989; 63: 66–70.
9. Yang J, Zhang J, Cui W et al. Cardioprotective effects of single oral dose of nicorandil before selective percutaneous coronary intervention. Anadolu Kardiyol Derg 2015; 15 (2): 125–31.
10. Airaksinen KE, Huikuri HV. Antiarrhythmic effect of repeated coronary occlusion during balloon angioplasty. J Am Coll Cardiol 1997; 29 (5): 1035.
11. Sakamoto T, Kaikita K, Miyamoto S et al. Effects of nicorandil on endogenous fibrinolytic capacity in patients with coronary artery disease. Circ J 2004; 68: 232–56.
12. Izumiya Y, Kojima S, Araki S et al. Long-term use of oral nicorandil stabilizes coronary plaque in patients with stable angina pectoris. Atherosclerosis 2011; 214 (2): 415–21.
13. Markham A, Plosker GL, Goa KL. Nicorandil. An updated review of its use in ischaemic heart disease with emphasis on its cardio-protective effects. Drugs 2000; 60: 955–74.
14. Sekiya M, Sato M, Funada J et al. Effects of the long-term administration of nicorandil on vascular endothelial function and the progression of arteriosclerosis. J Cardiovasc Pharmacol 2005; 46 (1): 63–7.
15. Kasama S, Toyama T, Sumino H et al. Long-term nicorandil therapy improves cardiac sympathetic nerve activity after reperfusion therapy in patients with first acute myocardial infarction. J Nucl Med 2007; 48 (10): 1676–82.
16. Kasama S, Toyama T, Hatori T et al. Comparative effects of nicorandil with isosorbide mononitrate on cardiac sympathetic nerve activity and left ventricular function in patients with ischemic cardiomyopathy. Am Heart J 2005; 150 (3): 477.e1–477.e8.
17. The IONA Study Group. Effect of nicorandil on coronary events in patients with stable angina: the Impact Of Nicorandil in Angina (IONA) randomised trial. Lancet 2002; 359: 1269–75.
18. The IONA Study Group. Impact of nicorandil in angina: subgroup analyses. Heart 2004; 90: 1427–30.
19. Horinaka S, Yabe A, Yagi H et al. Effects of nicorandil on cardiovascular events in patients with coronary artery disease in the Japanese Coronary Artery Disease (JCAD) study. Circ J 2010; 74 (3): 503–9.
20. Sakata Y, Nakatani D, Shimizu M et al. Oral treatment with nicorandil at discharge is associated with reduced mortality after acute myocardial infarction. J Cardiol 2012; 59 (1): 14–21.
21. Bulakhova E.Iu., Korennova O.Iu., Kondrasheva M.N. i dr. Klinicheskie preimushchestva terapii nikorandilom po sravneniiu s izosorbid-5-mononitratom u bol'nykh IBS. Serdtse. 2013; 12, №2 (70): 83–7. [in Russian]
22. Rezvanova Iu.A., Adamchik A.S. Otsenka antiishemicheskoi i kardioprotektivnoi effektivnosti nikorandila u patsientov so stabil'noi stenokardiei. Kardiologiia. 2015 8 (55): 21–5. [in Russian]
23. Riabikhin E.A., Mozheiko M.E., Krasil'nikova Iu.A. i dr. Dopolnitel'nye vozmozhnosti v lechenii ishemicheskoi bolezni serdtsa, oslozhnennoi khronicheskoi serdechnoi nedostatochnost'iu s nizkoi fraktsiei vybrosa levogo zheludochka. Serdechnaia nedostatochnost'. 2016; 17 (1): 3–9. [in Russian]
24. Weisz G, Généreux P, Iñiguez A et al. for the RIVER-PCI investigators. Ranolazine in patients with incomplete revascularisation after percutaneous coronary intervention (RIVER-PCI): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet 2016; 387: 136–45.
25. Alexander KA, Weisz G, Prather K et al. Effects of Ranolazine on Angina and Quality of Life After Percutaneous Coronary Intervention With Incomplete Revascularization Results From the Ranolazine for Incomplete Vessel Revascularization (RIVER-PCI) Trial. Circulation 2016; 133: 39–47.
26. Takahashi J et al. Prognostic impact of chronic nitrate therapy in patients with vasospastic angina: multicentre registry study of the Japanese coronary spasm association. Eur Heart J 2015; 36: 228–37. Doi:10.1093/eurheartj/ehu313.
27. Boden WE, O’Rourke RA, Teo KK et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 2007; 356: 1503–16.
28. Sedlis SP, Hartigan PM, Teo KK et al. For the COURAGE Trial Investigators. Original Effect of PCI on Long-Term Survival in Patients with Stable Ischemic Heart Disease. N Engl J Med 2015; 373: 1937–46.
29. 2014 ESC/EACTS Guidelines on myocardial revascularization. The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2014. Doi: 10.1093/eurheartj/ehu278.
30. Kiramijyan S, Liu MW. The benefits of drug-eluting stents in the treatment of coronary artery disease. Res Rep Clin Cardiol 2016; 7: 9–25.
31. Bangalore S, Toklu B, Feit F. Outcomes with coronary artery bypass graft surgery versus percutaneous coronary intervention for patients with diabetes mellitus: can newer generation drug-eluting stents bridge the gap? Circ Cardiovasc Interv 2014; 7 (4): 518–25.
32. Campos CM, Christiansen EH, Stone GW, Serruys PW. The EXCEL and NOBLE trials: similarities, contrasts and future perspectives for left main revascularisation. Euro Intervention 2015; 11 (Suppl. V): V115–V119.
Авторы
Ю.А.Карпов
ФГБУ Российский кардиологический научно-производственный комплекс Минздрава России. 121552, Россия, Москва, ул. 3-я Черепковская, д. 15а yuri_karpov@inbox.ru
________________________________________________
Yu.A.Karpov
Russian Cardiological Scientific-Industrial Complex of the Ministry of Health of the Russian Federation. 121552, Russian Federation, Moscow, 3-ia Cherepkovskaia, d. 15a yuri_karpov@inbox.ru