Michalis L K, Stroumbis C S, Pappas K, Sourla E, Niokou D, Goudevenos J A, Siogas C, Sideris D A
School of Medicine, Department of Internal Medicine, Division of Cardiology, University Campus, University of Ioannina, Ioannina, Greece.
Eur Heart J. 2000 Dec;21(23):1954-9. doi: 10.1053/euhj.2000.2397.
We compared invasive (on-site coronary angioplasty or emergency air-ambulance transfer for bypass grafting surgery) vs conservative (persistent medical treatment) strategies in the management of refractory unstable angina in geographically isolated hospitals without cardiac surgical facilities.
One hundred and forty eight randomized patients with refractory unstable angina were compared on an intention-to-treat basis. Outcomes (invasive vs conservative): (a) in hospital: stabilization (96% vs 43%, P=0.0001), non-fatal myocardial infarction (2.6% vs 4.2%, P=ns), death (1.3% vs 8.3%, P=0.046), combined outcome (3.9% vs 12.5%, P=0.053) and hospitalization (11.4+/-6.3 vs 12.4+/-8.0 days, P=ns). (b) 30-days follow-up: non-fatal myocardial infarction (2.6% vs 4.2%, P=ns), death (2.6% vs 11.1%, P=0.030) and combined outcome (5.3% vs 15.3%, P=0.031). (c) 12 month follow-up: non-fatal myocardial infarction (3. 9% vs 4.2%, P=ns), death (3.9% vs 12.5%, P=0.053), combined outcome (7.9% vs 16.7%, P=ns), re-admissions for unstable angina: (17.1% vs 23.6%, P=ns), late coronary angioplasty: (15.8% vs 11.1%, P=ns) and (d) late coronary bypass grafting: (7.9% vs 12.5%, P=ns).
Invasive treatment of patients with refractory angina in remote areas without surgical back-up results in significant in-hospital stabilization and a reduction in major events in-hospital and at 30 days. Coronary angioplasty in stand-alone units and air-transfer of these patients seems safe.
我们比较了在没有心脏外科设施的偏远地区医院中，对难治性不稳定型心绞痛采用侵入性策略（现场冠状动脉血管成形术或紧急空中救护转运以进行搭桥手术）与保守策略（持续药物治疗）的效果。
148例难治性不稳定型心绞痛患者按意向性分析原则进行比较。结果（侵入性策略与保守策略相比）：（a）住院期间：病情稳定（96%对43%，P = 0.0001）、非致命性心肌梗死（2.6%对4.2%，P = 无统计学意义）、死亡（1.3%对8.3%，P = 0.046）、综合结果（3.9%对12.5%，P = 0.053）以及住院时间（11.4±6.3天对12.4±8.0天，P = 无统计学意义）。（b）30天随访：非致命性心肌梗死（2.6%对4.2%，P = 无统计学意义）、死亡（2.6%对11.1%，P = 0.030）以及综合结果（5.3%对15.3%，P = 0.031）。（c）12个月随访：非致命性心肌梗死（3.9%对4.2%，P = 无统计学意义）、死亡（3.9%对12.5%，P = 0.053）、综合结果（7.9%对16.7%，P = 无统计学意义）、因不稳定型心绞痛再次入院（17.1%对23.6%，P = 无统计学意义）、晚期冠状动脉血管成形术（15.8%对11.1%，P = 无统计学意义）以及（d）晚期冠状动脉搭桥手术（7.9%对12.5%，P = 无统计学意义）。
在没有手术支持的偏远地区，对难治性心绞痛患者进行侵入性治疗可显著实现住院期间病情稳定，并减少住院期间及30天内的重大事件。在独立单位进行冠状动脉血管成形术以及对这些患者进行空中转运似乎是安全的。
