Episodes Of Angina Research Articles

Shenzhu Guanxin Recipe Granules () for Improving Exercise Tolerance in Patients with Stable Angina (SERIES Trial): A Protocol of Multicenter, Randomized, Double-Blind, Placebo Parallel Controlled Clinical Trial.

Many patients with chronic angina experience anginal episodes despite successful recanalization, antianginal and antiischemic medications. Empirical observations suggested that Shenzhu Guanxin Recipe Granules (, SGR), a Chinese herbal compound, exerted potential impacts on increased treadmill exercise performance and angina relieve. However, there has been no systematic study to clarify the impact of SGR on exercise tolerance in patients with stable angina. The SERIES (ShEnzhu guanxin Recipe for Improving Exercise tolerance in patients with Stable angina) trial is designed to determine the effects of SGR on exercise duration, electrocardiographic (ECG) evidence of myocardial ischemia, and incidence of major adverse cardiac events (MACE) in stable anginal patients. A total of 184 eligible patients with stable angina will be randomly assigned to receive placebo or SGR (10 g/day for 12 weeks) in a 1:1 ratio. The primary outcome will be the change from baseline in total exercise tolerance duration, time to onset of angina and ECG ischemia during exercise treadmill testing performed over a 12-week study period. The secondary outcome will include ECG measures, the occurrence and composite of MACE and the Seattle Angina Questionnaire score. Moreover, the coronary microcirculation will be evaluated to explore the possible effects in response to treatment of SGR. After the procedure, all participants will be followed up by interview at 3 and 6 months, enquiring about any cardiac events, hospitalizations, cardiac functional level and medication usage. Additionally, the occurrence of adverse events will be evaluated at each follow-up. This study may provide novel evidence on the efficacy of SGR in improving exercise tolerance and potentially reducing clinical adverse events. (Trial registration No. ChiCTR-TRC-14004504).

Perioperative major acute cardiovascular events after 180-W GreenLight laser photoselective vaporization of the prostate.

Major acute cardiovascular events (MACE) prevalence after 180-W GreenLight (180-W GL) laser photoselective vaporization (PVP) have never been explored. Aim of our study is to evaluate perioperative MACE that occurred concomitantly with 180-W GL PVP. We relied on a multi-institutional database that included 14 centers. Data from 923 patients who underwent 180-W GL PVP were reviewed. We abstracted pre- and perioperative data of patients who experienced perioperative MACE, such as angina pectoris, acute myocardial infarction, other chronic ischemic heart disease, transient ischemic attack, or cerebrovascular accident as well as deep venous thrombosis with or without pulmonary embolism. We relied on a case-series format to report the main findings of our analyses. 18 (1.9%) patients reported MACE in 7 centers. Median age was 69.5 (IQR 66.0-79.2) years. Of all, 7 patients underwent standard PVP and 11 anatomical PVP. Eleven patients (61.1%) were not under anticoagulant/antiplatelet treatment, 6(33.3%) were under low dose aspirin, and 1 (5.6%)was under clopidogrel. Four patients(22.2%) had an instrumental and laboratory diagnosis of myocardial infarction, 7(38.9%) had an episode of angina pectoris with or without rhythm alteration, 3(16.7%) reported symptomatic deep venous thrombosis, and 4(22.2%) had other MACE-like events. Physician should take in consideration the possibility of MACE or MACE-like events. The real MACE rate may be different as only half of included centers reported MACE. Since the main target of laser surgery are high-risk bleeding patients, prospective observational trials focused on detection of these possible complications are warranted.

Acute Coronary Syndrome Following Long-Term Erlotinib Treatment

Abstract Introduction. The treatment of neoplasia has advanced due to targeted molecular therapies. Erlotinib, a tyrosine kinase inhibitor that acts by blocking epidermal growth factor receptor (EGFR), is used to treat advanced or metastatic chemotherapy-resistant non-small cell lung cancers (NSCLC). Erlotinib is a safe and well tolerated medication. Although the most common adverse effects are cutaneous or gastrointestinal, its cardiotoxicity is an important topic in the treatment and follow-up of neoplastic patients. Clinical case. A 76-year-old male patient with 40 Pack Year history of smoking that has quitted 20 years ago, was admitted in 2009 for night sweats, dry cough and weight loss. He is diagnosed with lung cancer in the right upper lobe (T4N2M1), with the histopathological diagnosis of clear cell adenocarcinoma. The patient performs radiotherapy and chemotherapy with 6 series of Gemcitabine and Cisplatin with partial response, followed by Erlotinib treatment with favorable progression with regression of tumor size. In December 2017, he presents recurrent episodes of atypical angina lasting about 2 weeks. The electrocardiographic examination reveals ST segment elevation, with tall T waves and Q waves are present in the lower branches, associated with the increase of myocardial necrosis enzymes. Echocardiography highlights inferior hypokinesia with left ventricle ejection rate estimated at 45%. The patient has a favorable evolution during admission without recurrence of pain. Coronary angiography is performed at distance with evidence of vascular atherosclerotic lesions and the installation of active pharmacodynamic stents. Discussions. Tyrosine kinase inhibitors may be the cause of acute coronary events both by affecting myocardiocytes following EGFR inhibition, but also by increasing atheromatic plaque instability and by prolonging theQT segment. In conclusion a systemic cardiologic assessment of Erlotinib-treated patients may be recommended throughout the course of therapy.

Effects of health education based on health beliefs on negative emotions and quality of life in patients with acute myocardial infarction after PCI

Objective To investigate the effects of health education based on health beliefs on the care effect of patients with acute myocardial infarction(AMI) after percutaneous coronary intervention(PCI) and their clinical compliance, nursing satisfaction and quality of life. Methods A total of 100 patients with AMI in this hospital were treated with PCI and divided into control group and study group according to the order of admission, 50 cases of each group.Usual care intervention was given to the control group after operation.Health education based on health faith was applied to the research group on the basis of usual care after operation.Treatment compliance, nursing satisfaction and postoperative adverse cardiac events, length of stay, number of angina episodes were statistically compared between the two groups, and the quality of life and negative mood improvement condition before and after operation in the two groups were evaluated by SF-36 Quality of Life Questionnaire and the Hamilton Anxiety and Depression Scale(HAMA and HAMD). Results The hospitalization time, number of angina episodes in the study group were significantly lower than those in the control group after treatment(P<0.05). The treatment compliance and nursing satisfaction were higher than those in the control group(P<0.05). Compared with the control group, the scores of postoperative quality of life in the study group were significantly increased, and the differences were statistically significant(P<0.05). The scores of HAMA and HAMD in the postoperative study group were significantly lower than those before operation, and the study group was lower than that of the control group, and the difference was statistically significant(P<0.05). The incidence of postoperative cardiac adverse events in the study group was significantly lower than that of the control group, and the difference was statistically significant(P<0.05). Conclusion Treatment of patients with acute myocardial infarction after PCI using health education based on health beliefs can improve the postoperative negative emotion and improve the compliance and nursing satisfaction of the patients, and the effect is remarkable. Key words: Health beliefs; Health education; Acute myocardial infarction; PCI; Negative emotions; Quality of life

INFLUENCE OF TORASEMIDE ON ELECTRICAL INSTABILITY OF THE HEART IN PATIENTS WITH ISCHEMIC MITRAL REGURGITATION POST MYOCARDIAL INFARCTION

Aim. To assess the efficacy of torasemide for changes of electrical instability of the heart in patients with ischemic mitral regurgitation during the period after myocardial infarction. Material and methods. Ninety six patients with mitral regurgitation, with Q-myocardial infarction (Q-MI) had been randomized to two groups. During six months after discharge, in the control group 1, of 46 patients, the standard therapy applied (clopidogrel, acetylsalicylic acid, nebivolol, perindopril). In the study group 2, of 50 patients, additionally torasemide was used. At baseline, in 3 and 6 months Holter ECG monitoring was performed. Results. In the group 1 patients with mitral regurgitation post Q-MI, with the standard treatment, there was decrease of silent myocardial ischemia (3,6±0,5 — baseline; 3,3±0,5 and 3,1±0,3 — in 3 and 6 months, respectively, p 1 mm, number of patients with supra- and ventricular extrasystoles (p>0,05) and increase of the number of anginal ischemia (2,1±0,4 — baseline, 2,2±0,2 and 2,3±0,1 — in 3 and 6 months, respectively, p>0,05). In the group 2 patients, in 6 months of treatment there was decrease of number of silent (2,1±0,3) ischemia episodes, duration of anginal (7,3±2,1 min) and silent (4,3±1,2 min) ischemia comparing to baseline (8,8±1,2; 10,6±2,7 and 8,8±1,2 min — respectively, p 1 mm episodes (1,2±0,2 vs 2,0±0,4 mm at baseline) and relative values of the patients number with the registered supra- and ventricular extrasystoles (38% and 44%, respectively, versus 62% and 84% at baseline, p>0,05). Conclusion. The usage of torasemide combination with standard treatment decreases the number of episodes, duration of silent and anginal myocardial ischemia, rate of registered supra- and ventricular extrasystoles in mitral regurgitation patients post Q-MI, comparing to separate standard treatment. Also, the rate of anginal ischemia episodes does not change in 3 and 6 months of standard treatment.

A comprehensive meta-analysis of stem cell therapy for chronic angina.

A substantial proportion of patients with coronary artery disease do not achieve complete revascularization and continue to experience refractory angina despite optimal medical therapy. Recently, stem cell therapy has emerged as a potential therapeutic option for these patients. However, findings of individual trials have been scrutinized because of their small sample sizes and lack of statistical power. Therefore, we conducted an updated comprehensive meta-analysis of available randomized controlled trials (RCTs) with the largest sample size ever reported on this subject. In patients with chronic angina stem cell therapy improves clinical outcomes. Scientific databases and websites were searched for RCTs. Data were independently collected by 2 investigators, and disagreements were resolved by consensus. Data from 10 trials including 658 patients were analyzed. Stem cell therapy improved Canadian Cardiovascular Society angina class (risk ratio: 1.53, 95% CI: 1.09 to 2.15, P = 0.013), exercise capacity (standardized mean difference [SMD]: 0.56, 95% CI: 0.23 to 0.88, P = 0.001), and left ventricular ejection fraction (SMD: 0.63, 95% CI: 0.27 to 1.00, P = 0.001) compared with placebo. It also decreased anginal episodes (SMD: -1.21, 95% CI: -2.40 to -0.02, P = 0.045) and myocardial perfusion defects (SMD: -0.70, 95% CI: -1.11 to -0.29, P = 0.001). However, no improvements in all-cause mortality were observed after a relatively short follow-up. In patients with chronic angina on optimal medical therapy, stem cell therapy improves symptoms, exercise capacity, and left ventricular ejection fraction. These findings warrant confirmation using larger trials.

Clinical profile of patients with acute coronary syndrome and its association with biomarker troponin I

Background: In patients with acute coronary syndromes, it is desirable to identify a sensitive serum marker that is closely related to the degree of myocardial damage, provides prognostic information, and can be measured rapidly. Author studied the clinical profile of patients with Acute MI and its relation with troponin I level.Methods: In this prospective study, 65 patients admitted with Acute MI were studied. Study patients were divided in Troponin I positive and Troponin I negative group. Patients were followed up to discharge or death in the hospital.Results: Most common symptom present in the patients with Acute Coronary Syndrome was chest pain (94%) and most common risk factor was dyslipidaemia (72.3%). Most common complication was recurrent angina (72.3%). Out of total patients with significant CAD, almost 70 % belong to Troponin I positive group and it is statistically highly significant (p&lt;0.05). Total 30 patients (46.2%) have more than 10 episodes of angina in our study. There is statistically significant association between number of angina episode and Troponin I positivity (p&lt;0.05). Out of total deaths, 73.3% have occurred among Troponin I positive study patients and it is statistically significant (p&lt;0.05).Conclusions: In patients with acute coronary syndromes, cardiac troponin I levels provide useful prognostic information and permit the early identification of patients with an increased risk of death.

Prospective analysis of lipid profile parameters and markers of vascular inflammatory response with prognosis of undesirable coronary events in patients with coronary heart disease after angioplasty with stenting.

The study of the causes of the development of vascular coronary complications after angioplasty with stenting using the evaluation of biochemical parameters in the dynamic observation of patients with IHD with significant coronary stenosis determines the relevance of the study. To analyze the parameters of lipid spectrum and markers of vascular inflammatory reaction in patients with IHD, in groups with stable angina and episode of unstable angina after angioplasty with stenting, to trace the dynamics of biochemical parameters and to reveal the predictors of undesirable coronary events. Patients with IHD with significant coronary stenosis of the arteries (SCS, n = 95) after coronary angiography at the point of maximum increase in the level of markers of the inflammatory reaction (3 months after angioplasty) are divided into 2 groups - patients with persistent stable angina pectoris (SA, n = 77) until the end of the study and patients with developed postvascularization episode of unstable angina (UA, n = 18). The dynamics of observation of biochemical parameters recorded the absence of normalization of the atherogenic spectrum of the lipid profile and the prolonged nature of the vascular inflammatory response to the end point of observation after angioplasty.The method of binary logistic regression revealed that in the general group of patients with IHD, an increase in the level of low density lipoprotein cholesterol by 1 mmol / L significantly increases the probability of significant coronary stenosis in men and raises the risk of UA after angioplasty by 7.38 times. It was found that patients with UA at the initial stage have a significantly higher risk of coronary blood flow instability in the post-vascularization period due to an elevated level of homocysteine. A set of biochemical markers for predicting the significance of coronary stenosis and development of undesirable vascular coronary events after angioplasty in patients with IHD has been identified: male sex, elevated LDL cholesterol and hyperhomocysteinemia.

Effects of glargine insulin on glycemic control in patients with diabetes mellitus type II undergoing off-pump coronary artery bypass graft.

Background:The prevalence of diabetes mellitus in patients requiring coronary artery bypass grafting (CABG) is noticeably high (20%–30%). These patients have inferior perioperative outcome, reduced long-term survival, and high risk of recurrent episodes of angina. To improve perioperative outcome surgical unit defined satisfactory glycemic control is desired during this period. Hence, the aim of our study is to compare the efficacy of glargine insulin combination with continuous human insulin infusion for perioperative glycemic control in patients with diabetes undergoing CABG.Materials and Methods:Fifty Patients, who were posted for off-pump CABG with diabetes mellitus type II, were randomized in two group, Group I normal saline + human insulin infusion during the perioperative period, Group II (glargine group): Glargine + human insulin infusion during perioperative period.Results:During surgery and in the postoperative period, random blood sugar and human insulin requirement are significantly higher in control group than glargine group. Other infection, step-up antibiotics, intensive care unit (ICU) stay, and hospital stay were significantly higher in control groups in postoperative period.Conclusion:Our study results suggest that glargine effectively manages blood glucose level with significantly greater control over postoperative morbidity.

Effect of preinfarction angina on primary percutaneous coronary intervention outcomes

Background: Preinfarction angina has been recognized as a surrogate for preconditioning episodes. This study was designed to evaluate the cardiovascular effects of preinfarction anginal episodes among acute myocardial infarction (AMI) patients undergoing primary percutaneous coronary intervention (PCI). Materials and Methods: Of 520 patients who had undergone primary PCI, 393 patients were finally included in a prospective cohort study. Standard primary PCI procedure according to the latest guidelines was performed. The patients were divided into three groups based on previous symptoms as follows: asymptomatic (Group A), chronic stable angina (Group B) and unstable angina (Group C). Results: A total of 393 patients were evaluated. 185 (47.1%) patients were described as asymptomatic, 48 (12.2%) had stable angina and 160 (40.7%) were categorized as unstable angina. There was no significant difference among the study groups regarding pre- and post-PCI thrombolysis in myocardial infarction flow grade (P = 0.81). Median of peak post-PCI creatine-kinase-muscle/brain level of Group A (asymptomatic) was 250.5 (115.5–389), and it was significantly higher than Group C (176 [60.00–313.50]) (P = 0.03). Q wave formation was observed in 142 (88.75%), 31 (64.5%), and 96 (52.0%) patients of Group A, B, and C patients, respectively, which was significantly higher in asymptomatic patients (P = 0.002). There was no significant difference among the three groups regarding in-hospital and 6-month mortality (P = 0.36, 0.06, respectively). The composite endpoint of 6-month mortality, acute coronary events, cerebrovascular accidents, and target vessel revascularization was not significantly different between the three groups (P = 0.11). Conclusion: Preinfarction angina among AMI patients undergoing primary PCI seems to have a limited beneficial effect on infarct size, and this benefit was not translated to any clinical benefit.

Microvascular Angina - Long-Term Exercise Stress Test Follow-up.

A sizeable proportion of patients with primary stable microvascular angina (MVA; exercise-induced angina, positive exercise stress test [EST], normal coronary arteries) have recurrent symptoms during follow-up. There have been no previous studies, however, on the long-term results of EST and their correlation with symptom outcome.Methods and Results:Follow-up EST was performed in 71 MVA patients at an average of 16.2 years (range, 5-25 years) from the first EST. Angina status was assessed on weekly frequency of angina episodes and nitroglycerin consumption and by whether symptoms had worsened, improved, or remained unchanged over time. At follow-up EST, 41 patients (group 1) had exercise-induced ischemia, whereas 30 patients (group 2) had negative EST. Compared to group 2, group 1 patients more frequently had exercise-induced dyspnea, and had a greater maximum ST-segment depression and a lower coronary blood flow response to adenosine and cold pressor test, but group 2 patients had a more frequent history of rest angina. No differences between the 2 groups were found at follow-up in angina status or change in symptom status during follow-up. Electrocardiogram results improve significantly in a sizeable proportion of patients with MVA. Changes in EST results, however, were not associated with clinical outcome.

Obstructive coronary artery disease in patient with acute thrombotic thrombocytopenic purpura

Thrombotic thrombocytopenic purpura (TTP) affects essentially all organ systems. Myocardial injury in TTP is often attributed to microthrombi formation. We present the first case report in the literature of an...

Refractory Chest Pain or Treating Cardiologist's Bane: A Case Report

AbstractMicrovascular angina is caused by dysfunction of small-resistance coronary arteries (&lt; 500 µm) and is of heterogenous origin. The major epicardial coronaries are normal and commonly seen in women. Prognosis is variable, with disabling angina in many patients and can be a cause of mortality, especially in those who are refractory to treatment. In this background, we present a case of 56-year-old post valve replacement with normally functioning aortic valve and recurrent episodes of microvascular angina. The patient had normal epicardial coronaries. She had recurrent episodes of angina refractory to various antianginals associated with hemodynamic instability. Microvascular angina can curtail routine activity, frequent hospitalization, and repeated noninvasive and invasive investigations. Thus, it is a high social and economical disease, especially pertinent to women.

The challenges of treating recurrent polymorphic ventricular tachycardia due to coronary vasospasm: Lessons from an interesting case

Coronary artery vasospasm can cause recurrent anginal episodes with ST-segment elevation. Vasospasm induced myocardial ischemia can lead to arrhythmias including life threatening ventricular tachycardia (VT). Percutaneous coronary intervention (PCI), although not routinely recommended for treating vasospastic angina, can be considered for discrete coronary spasm that is not amenable to vasodilator therapy. We present a challenging case of a 41-year-old lady with recurrent episodes of vasospastic angina and VT refractory to medical therapy, which was successfully treated with PCI and an implantable cardioverter defibrillator.

WITHDRAWN: Trimetazidine for stable angina.

Patients with stable angina not controlled by monotherapy with nitrates, beta blockers, or calcium channel blockers are often treated with combinations of these drugs. There may be adverse effects from, or contraindications to, the use of combinations. In low risk groups, medical treatment appears to be as good an option as percutaneous transluminal coronary angioplasty in terms of averting myocardial infarction, death, or subsequent revascularization. Revascularization procedures are too costly or inaccessible for many patients in developing countries therefore effective and safe medical treatment is needed. Trimetazidine is a less well known anti-anginal drug that controls myocardial ischaemia through intracellular metabolic changes. Trimetazidine has been reported, in some studies, to be better tolerated than combined anti-anginal therapy; however it is not considered in published guidelines. To determine the efficacy and tolerability of trimetazidine in patients with stable angina. We searched The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, LILACS and SCISEARCH, without language restriction, from inception to October 2003. Experts in the field were contacted to locate unpublished studies. Randomised studies comparing trimetazidine with placebo, or other anti-angina drug in adults with stable angina. Two reviewers independently applied the inclusion criteria, assessed trial quality and extracted data. Twenty-three studies (1378 patients) met the inclusion criteria. There was a paucity of information about mortality, cardiovascular events and quality of life. Trimetazidine, compared with placebo, reduced the number of weekly angina attacks ( mean difference -1.44, 95% CI -2.10 to -0.79; P < 0.0001), reduced weekly nitroglycerin tablet consumption (95% CI -1.47 to -2.20, -0.73; P < 0.0001) and improved exercise time to 1 mm segment depression (P = 0.0002). Four small trials (263 patients) compared trimetazidine against other anti-anginal agents. One favoured trimetazidine over nitrates. Three tended to favour alternative regimens but with confidence intervals consistent with both major increases and decreases in frequency of angina episodes. In this subgroup, adverse events were considered in 5 trials (448 patients) and totals of 2 versus 12 drop outs due to adverse events were observed in the trimetazidine and alternative regimens respectively, but this was mostly driven by a single trial. Trimetazidine is effective in the treatment of stable angina compared with placebo, alone or combined with conventional anti-anginal agents. Trimetazidine may result in fewer dropouts due to adverse events. Large, long term trials comparing trimetazidine with other anti-anginal drugs assessing clinically relevant important outcomes are required to establish its role in clinical management.

Real-world Evidence for the Antianginal Efficacy of Trimetazidine fromtheRussian Observational CHOICE-2 Study.

The guidelines recommend a beta-blocker or calcium channel blocker as the first-line medication for angina, supplemented by other agents for additional symptoms. One such agent is trimetazidine (TMZ), which has been shown to reduce the frequency of anginal episodes and improve exercise performance without affecting haemodynamic parameters. However, extensive real-world evidence for its efficacy in combination with first-line therapies has been lacking. The aim of this large-scale, Russian, multicentre, 6-month, open-label, prospective observational study was to assess the effect of adding TMZ modified release 35mg bid to background antianginal therapy in the real-world clinical setting. The study included 896 patients: 54% women, aged 29-90years (42.6% >65years), 63% with class II angina, and receiving beta-blockers alone or in combination (93%). Add-on TMZ reduced angina frequency and short-acting nitrate use within 2weeks (both p<0.0001) regardless of background therapy and maintained this effect over 6months. It increased the proportion of patients with class I angina sixfold while decreasing that of class 3 angina almost fourfold. It also improved walking distance and well-being at 6months (both p<0.0001). Treatment was well tolerated. Add-on TMZ is a safe and rapidly effective treatment for reducing angina attacks and nitrate use in the real-world clinical setting. It also increases exercise capacity and well-being. These effects are observed within 2weeks and persist for at least 6months.

Ranolazine for stable angina pectoris.

Stable angina pectoris is a chronic medical condition with significant impact on mortality and quality of life; it can be macrovascular or microvascular in origin. Ranolazine is a second-line anti-anginal drug approved for use in people with stable angina. However, the effects of ranolazine for people with angina are considered to be modest, with uncertain clinical relevance. To assess the effects of ranolazine on cardiovascular and non-cardiovascular mortality, all-cause mortality, quality of life, acute myocardial infarction incidence, angina episodes frequency and adverse events incidence in stable angina patients, used either as monotherapy or as add-on therapy, and compared to placebo or any other anti-anginal agent. We searched CENTRAL, MEDLINE, Embase and the Conference Proceedings Citation Index - Science in February 2016, as well as regional databases and trials registers. We also screened reference lists. Randomised controlled trials (RCTs) which directly compared the effects of ranolazine versus placebo or other anti-anginals in people with stable angina pectoris were eligible for inclusion. Two authors independently selected studies, extracted data and assessed risk of bias. Estimates of treatment effects were calculated using risk ratios (RR), mean differences (MD) and standardised mean differences (SMD) with 95% confidence intervals (CI) using a fixed-effect model. Where we found statistically significant heterogeneity (Chi² P < 0.10), we used a random-effects model for pooling estimates. Meta-analysis was not performed where we found considerable heterogeneity (I² ≥ 75%). We used GRADE criteria to assess evidence quality and the GRADE profiler (GRADEpro GDT) to import data from Review Manager 5.3 to create 'Summary of findings' tables. We included 17 RCTs (9975 participants, mean age 63.3 years). We found very limited (or no) data to inform most planned comparisons. Summary data were used to inform comparison of ranolazine versus placebo. Overall, risk of bias was assessed as unclear.For add-on ranolazine compared to placebo, no data were available to estimate cardiovascular and non-cardiovascular mortality. We found uncertainty about the effect of ranolazine on: all-cause mortality (1000 mg twice daily, RR 0.83, 95% CI 0.26 to 2.71; 3 studies, 2053 participants; low quality evidence); quality of life (any dose, SMD 0.25, 95% CI -0.01 to 0.52; 4 studies, 1563 participants; I² = 73%; moderate quality evidence); and incidence of non-fatal acute myocardial infarction (AMI) (1000mg twice daily, RR 0.40, 95% CI 0.08 to 2.07; 2 studies, 1509 participants; low quality evidence). Add-on ranolazine 1000 mg twice daily reduced the fervour of angina episodes (MD -0.66, 95% CI -0.97 to -0.35; 3 studies, 2004 participants; I² = 39%; moderate quality evidence) but increased the risk of non-serious adverse events (RR 1.22, 95% CI 1.06 to 1.40; 3 studies, 2053 participants; moderate quality evidence).For ranolazine as monotherapy compared to placebo, we found uncertain effect on cardiovascular mortality (1000 mg twice daily, RR 1.03, 95% CI 0.56 to 1.88; 1 study, 2604 participants; low quality evidence). No data were available to estimate non-cardiovascular mortality. We also found an uncertain effect on all-cause mortality for ranolazine (1000 mg twice daily, RR 1.00, 95% CI 0.81 to 1.25; 3 studies, 6249 participants; low quality evidence), quality of life (1000 mg twice daily, MD 0.28, 95% CI -1.57 to 2.13; 3 studies, 2254 participants; moderate quality evidence), non-fatal AMI incidence (any dose, RR 0.88, 95% CI 0.69 to 1.12; 3 studies, 2983 participants; I² = 50%; low quality evidence), and frequency of angina episodes (any dose, MD 0.08, 95% CI -0.85 to 1.01; 2 studies, 402 participants; low quality evidence). We found an increased risk for non-serious adverse events associated with ranolazine (any dose, RR 1.50, 95% CI 1.12 to 2.00; 3 studies, 947 participants; very low quality evidence). We found very low quality evidence showing that people with stable angina who received ranolazine as monotherapy had increased risk of presenting non-serious adverse events compared to those given placebo. We found low quality evidence indicating that people with stable angina who received ranolazine showed uncertain effect on the risk of cardiovascular death (for ranolazine given as monotherapy), all-cause death and non-fatal AMI, and the frequency of angina episodes (for ranolazine given as monotherapy) compared to those given placebo. Moderate quality evidence indicated that people with stable angina who received ranolazine showed uncertain effect on quality of life compared with people who received placebo. Moderate quality evidence also indicated that people with stable angina who received ranolazine as add-on therapy had fewer angina episodes but increased risk of presenting non-serious adverse events compared to those given placebo.

CRT-200.07 Impact Of Ranolazine On Coronary Microvascular Function (MICRO Study)

Patients with angina and coronary microvascular dysfunction (CMVD) in the absence of obstructive epicardial coronary artery disease (CAD) or structural heart disease (Type 1 CMVD) remain without evidence based treatment options. Ranolazine has been shown to reduce frequency of angina episodes among

Coronary Artery Vasospasm in a Patient with Probable Churg Strauss Syndrome

Case: A 56-year-old male ex-smoker presented with an inferoposterior STEMI, after recent episodes of Prinzmetal angina. His history included dyslipidaemia, adult-onset asthma, allergic rhinitis, and gastric reflux. Whilst awaiting primary PCI, the patient suffered a bradycardic arrest, necessitating CPR, thrombolysis and DC cardioversion for VF, resulting in ROSC (total resuscitation time 40 minutes). Coronary angiography revealed only minor coronary artery disease. Findings were in keeping with coronary artery vasospasm, and a calcium channel blocker and nitrate were commenced. An AICD was inserted. Peripheral eosinophilia (4.0 × 109/L) was present, and further investigation revealed that the patient had eosinophilic infiltrates in the sinuses and oesophagus, an elevated IgE and a positive ANCA. Respiratory function tests revealed a moderately severe obstructive defect. CT imaging showed extensive opacification of the sinuses, nasal polyposis and diffuse oesophageal thickening. A diagnosis of probable Churg Strauss Syndrome (CSS) was made, although definitive evidence of vasculitis was lacking. Other hypereosinophilic disorders were excluded or thought unlikely. The patient was commenced on prednisolone and azathioprine, with almost complete control of asthma, rhinitis and oesophageal symptoms, associated with normalisation of the eosinophil count. He has been free of further cardiac events for over 12 months. Conclusion: Although CSS is associated with a number of cardiac manifestations, including myocarditis, heart failure, and sudden death, reports of coronary vasospasm are rare. This is a rare case of a patient with vasospastic acute coronary syndrome, who was eventually diagnosed with probable CSS. Patients presenting with cardiac pathology and eosinophilia should have further investigations.

Effect of Guanxin-Shutong capsule combined with western medicine routine treatment on vascular endothelial function in patients with unstable angina

Objective To investigate the effect of Guanxin-Shutong capsule combined with western medicine routine treatment on vascular endothelial function in patients with unstable angina pectoris. Methods A total of 100 UA patients were randomly divided into 2 groups with 50 patients in each group. The control group was treated with routine western medicine therapy. Based on the treatment of control group, the observation group used the Guanxin-Shutong capsule. The two groups were treated for 12 weeks. Vascular endothelial growth factor was determined by enzyme linked immunosorbent assay. Nitrate reductase method was used for the determination of NO. Clinical effects includeed the duration and number of episodes of angina pectoris. Results The serum levels of VEGF (599.22 ± 104.57 ng/L vs. 455.96 ± 99.15 ng/L, t=2.016), NO (42.31 ± 5.84 μmol/L vs. 35.02 ± 5.91 μmol/L, t=2.209) in the observation group were higher than those in the control group (P<0.05). The frequency (3.52 ± 0.68 vs. 4.12 ± 0.70, t=2.103) and duration of angina attack (2.74 ± 1.27 min vs. 4.32 ± 1.53 min, t=2.094) in the observation group were less than that in the control group (P<0.05). The total effect rate of observation group was 86% (43/50), and the control group was 70% (35/50), the difference was statistically significant between the 2 groups (χ2=3.730, P<0.05). Conclusions The Guanxin-Shutong capsule combined with western medicine conventional therapy can improve the symptoms of UA patients with angina pectoris, improve vascular endothelial function, reduce the frequency and duration of angina attack. Key words: Angina, unstable; Endothelium, vascular; Guanxin-Shutong capsule; Integrated Chinese traditional and western medicine therapy