Holmes D R
Mayo Clinic, Rochester, Minnesota 55905, USA.
Am J Cardiol. 2000 Dec 28;86(12B):36M-41M. doi: 10.1016/s0002-9149(00)01479-x.
Intensive medical therapy before percutaneous coronary intervention appears to improve results in patients with unstable angina and non-ST-segment elevation myocardial infarction (MI). In this review of treatment strategies for patients with acute coronary syndromes, an "aggressive conservative" approach based on that used in the FRagmin and Fast Revascularisation during InStability in Coronary artery disease (FRISC II) trial is recommended. In FRISC II, an early (but not emergent) invasive therapeutic procedure undertaken within 7 days of starting open-label dalteparin lowered the risk of death and MI in moderate- and high-risk patients and resulted in better and more rapid symptom relief and fewer hospital readmissions than the noninvasive approach. The early treatment period represents a critical juncture in the spectrum of care for patients with unstable angina and affords physicians the best opportunity to educate them about the importance of risk factor modification. Informed consent is also an important issue, particularly in the event of ad hoc coronary intervention. The optimal treatment plan must include considerations of length of hospitalization, medication requirements, and the potential for symptom recurrence or need for hospital readmission. Finally, tailoring therapy for individual patients and establishing appropriate timing of procedures will help ensure the best possible outcome.
在经皮冠状动脉介入治疗前进行强化医学治疗似乎可改善不稳定型心绞痛和非ST段抬高型心肌梗死（MI）患者的治疗结果。在本次对急性冠状动脉综合征患者治疗策略的综述中，推荐采用基于冠状动脉疾病不稳定期的Fragmin和快速血运重建（FRISC II）试验中所使用的“积极保守”方法。在FRISC II试验中，在开始使用开放标签的达肝素钠治疗7天内进行早期（但非紧急）侵入性治疗程序，可降低中高危患者的死亡和MI风险，并且与非侵入性方法相比，能更好、更快地缓解症状，减少再次入院。早期治疗阶段是不稳定型心绞痛患者治疗过程中的关键节点，为医生提供了最佳机会，向患者宣传危险因素调整的重要性。知情同意也是一个重要问题，特别是在进行临时冠状动脉介入治疗时。最佳治疗方案必须考虑住院时间、药物需求以及症状复发或再次入院的可能性。最后，为个体患者量身定制治疗方案并确定合适的手术时机，将有助于确保获得最佳治疗效果。
