Oral sirolimus: A possible treatment for refractory angina pectoris in the elderly

详细信息    查看全文

• 作者：Alexandru Mischie^a ; ^{alexandru_mischie@yahoo.com" class="auth_mail" title="E-mail the corresponding author} ; Sylvain Chanseaume^a ; ^{s.chanseaume@ch-montlucon.fr" class="auth_mail" title="E-mail the corresponding author} ; Philippe Gaspard^a ; ^{p.gaspard@ch-montlucon.fr" class="auth_mail" title="E-mail the corresponding author} ; Catalina Liliana Andrei^b ; ^{ccatalina97@yahoo.com" class="auth_mail" title="E-mail the corresponding author} ; Crina Sinescu^b ; ^{crinasinescu@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Michele Schiariti^c ; ^{michele.schiariti@uniroma1.it" class="auth_mail" title="E-mail the corresponding author}
• 关键词：RAP ; refractory angina pectoris ; CAD ; coronary artery disease ; PCI ; percutaneous coronary interventions ; CABG ; coronary artery by-pass graft ; QoL ; quality of life ; AP ; angina pectoris ; SCS ; spinal cord stimulation ; EECP ; enhanced external counter-pulsation ; SWT ; shock wave therapy ; TENS ; transcutaneous electrical nerve stimulation ; LV ; left ventricle ; OS ; oral sirolimus ; BMS ; bare metal stent ; LLL ; late luminal loss ; IVUS ; intravascular ultrasound ; TLR ; target lesion revascularization ; TVR ; targ
• 刊名：International Journal of Cardiology
• 出版年：2016
• 出版时间：1 November 2016
• 年：2016
• 卷：222
• 期：Complete
• 页码：1097-1104
• 全文大小：289 K

文摘

Refractory angina pectoris (RAP) is a clinical problem, frequently encountered in the elderly, associated with high health-care costs. Until recently, the goal of RAP treatment aimed at improving the quality of life (QoL) because it was thought that mortality rates were not different between stable angina pectoris and RAP. Our purpose was at determining whether any mortality rate difference exists and whether any novel therapeutical solution might be translated into clinical practice. We therefore performed a literature review to assess current optimal treatment of RAP patients, including all studies involving the use of oral sirolimus and stents, although no consistent evidence was found for any specific treatment to improve survival, apart from minor QoL amelioration. A large mortality difference was seen between RAP and stable angina pectoris. On the other hand, therapeutic approaches to RAP patients showed frequent complications and several contraindications, depending on the procedure.

We propose to inhibit instead of stimulating angiogenesis, by giving oral sirolimus, an immunosuppressive drug, thereby decreasing the atherosclerotic process and its evolution. Sirolimus was shown to decrease left ventricular mass (thus indirectly decreasing myocardial oxygen needs and consumption). It might stop and, in some cases, even enable regression of plaque progression. Sirolimus side effects are mild to moderate and wash-out rapidly at treatment discontinuation. Compared with current therapies sirolimus treatment is more health-care cost efficient. It should be important to design a trial in RAP patients powered to reduce mortality and QoL increase.