Murphy J J, Connell P A, Hampton J R
Department of Medicine, University Hospital, Nottingham.
Br Heart J. 1992 May;67(5):395-401. doi: 10.1136/hrt.67.5.395.
To observe the long-term prognosis of patients with unstable angina and select simple criteria to identify high and low risk subgroups.
A six month prospective survey with three year follow up.
One eleven bed coronary care unit.
All patients admitted with chest pain in whom no infarct was confirmed by subsequent electrocardiographic or enzyme changes and for whom no alternative cause of chest pain was found were studied. Unstable angina was also diagnosed if there was evidence of myocardial ischaemia in the form of previous effort angina, previous myocardial infarction, or if transient electrocardiographic changes accompanied the pain. When none of the above were present, chest pain without a known cause, was diagnosed.
No routine intervention. Angiography and revascularisation for persistent symptoms despite medical treatment.
Death or non-fatal infarction.
In the 141 patients with unstable angina there were eight deaths and five non-fatal infarctions during the first eight weeks. Symptoms of increasing angina before admission were similar in all three groups and did not help predict early complications. Recurrence of pain in hospital, a rise in cardiac enzymes to less than twice the upper limit of normal, and transient electrocardiographic changes were all associated with an increased risk of early events. The presence of either abnormal enzyme activity or more than five episodes of pain in hospital identified a group of 49 in whom 11 of the 13 early events occurred. After three years, 29 of the 141 patients had died and eight had had infarctions (overall event rate 26%). Seventeen had undergone revascularisation (12%) and 51 (36%) were on antianginal treatment. Thirty six (26%) were still alive, without new myocardial infarction, and were free of angina. In the 29 patients with chest pain without a known cause there were no early events and only one non-fatal infarction during the three year follow up.
When patients are admitted to the coronary care unit with chest pain not due to myocardial infarction, the history, electrocardiography and measurement of cardiac enzymes are sufficient to identify high and low risk subgroups.
观察不稳定型心绞痛患者的长期预后，并选择简单标准来识别高危和低危亚组。
为期6个月的前瞻性调查，并进行3年随访。
一个拥有11张床位的冠心病监护病房。
研究所有因胸痛入院且随后心电图或酶变化未证实有梗死且未发现其他胸痛原因的患者。如果有既往劳力性心绞痛、既往心肌梗死形式的心肌缺血证据，或疼痛伴有短暂心电图变化，也诊断为不稳定型心绞痛。当上述情况均不存在时，诊断为原因不明的胸痛。
无常规干预。经药物治疗后仍有持续症状者进行血管造影和血运重建。
死亡或非致命性梗死。
141例不稳定型心绞痛患者在最初8周内有8例死亡和5例非致命性梗死。入院前心绞痛加重的症状在所有三组中相似，无助于预测早期并发症。住院期间疼痛复发、心肌酶升高至正常上限的两倍以下以及短暂心电图变化均与早期事件风险增加相关。酶活性异常或住院期间疼痛发作超过5次可识别出49例患者，其中13例早期事件中有11例发生在该组。3年后，141例患者中有29例死亡，8例发生梗死（总事件发生率26%）。17例接受了血运重建（12%），51例（36%）接受抗心绞痛治疗。36例（26%）仍存活，无新发心肌梗死，且无心绞痛。在29例原因不明胸痛的患者中，3年随访期间无早期事件，仅有1例非致命性梗死。
当因非心肌梗死性胸痛入住冠心病监护病房的患者时，病史、心电图和心肌酶测量足以识别高危和低危亚组。
