UNSTABLE ANGINA - NATURAL-HISTORY AND DETERMINANTS OF PROGNOSIS
UNSTABLE ANGINA - NATURAL-HISTORY AND DETERMINANTS OF PROGNOSIS
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DOI：
10.1016/0002-9149(81)90083-7
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发表时间：
1981-01-01
影响因子：
2.8
通讯作者：
TOBIN, G
中科院分区：
文献类型：
--
作者：
MULCAHY, R;DALY, L;TOBIN, G
对101例不稳定型心绞痛患者进行保守治疗，未常规使用β受体阻滞剂、钙拮抗剂、抗凝剂或硝酸酯类药物。仅2例患者在住院期间接受了动脉造影术和冠状动脉搭桥术，1例患者在第1年随访研究期间接受了动脉造影术和冠状动脉搭桥术。28天死亡率为4%，1年总心源性死亡率为10%。2例患者死于癌症。非致命性心肌梗死的发生率在前28天为9%，第1年为3%。这些结果与使用不同治疗程序（包括现代强化药物治疗和冠状动脉搭桥手术）的其他研究报告的即刻和1年预后相比具有优势。在不稳定型心绞痛急性期研究的各种因素进行了评估，以预测的即时和长期的结果。只有持续的疼痛入院后被发现一个显着的指标，不良预后。现代医学治疗不稳定型心绞痛与β受体阻滞剂，钙拮抗剂药物，抗凝剂，硝酸盐和抗心律失常剂是严格审查。缺乏适当的随机对照研究证实药物的价值是强调。很少有证据表明，积极或强化的药物或手术治疗上级保守的方法来管理在冠心病监护病房。这种方法包括卧床休息，直到疼痛已经解决，对症药物治疗，最小限度地使用侵入性调查和仔细的风险因素干预。
One hundred one patients with unstable angina were treated conservatively without the routine use of beta receptor blocking agents, calcium antagonist drugs, anticoagulant agents or nitrates. Only two patients underwent arteriography and coronary arterial bypass surgery during hospitalization and one patient during the 1st year of follow-up study. The 28 day mortality rate was 4 percent and the total 1 year cardiac mortality rate 10 percent. Two patients died from carcinoma. The incidence rate of nonfatal myocardial infarction was 9 percent during the first 28 days and a further 3 percent for the 1st year. These results compare favorably with the immediate and 1 year prognosis reported from other studies using different treatment procedures, including modern intensive drug treatment and coronary arterial bypass surgery. Various factors studied during the acute stage of unstable angina were assessed in an effort to predict the immediate and long-term outcome. Only persistence of pain after admission to the hospital was found a significant indicator of an adverse prognosis.Modern medical treatment of unstable angina with beta receptor blocking agents, calcium antagonist drugs, anticoagulant agents, nitrates and antiarrhythmic agents is critically examined. The paucity of proper randomized controlled studies confirming the value of medication is underlined. There is little evidence to show that aggressive or intensive medical or surgical treatment is superior to a conservative approach to management in the coronary care unit. This approach includes bed rest until the pain has resolved, symptomatic drug treatment only, the minimal use of invasive investigations and careful risk factor intervention.