Uchida T, Kaneko N, Tanino S, Ogawa H, Iwasaki T, Sumiyoshi T, Hosoda S
Department of Cardiology Heart Institute of Japan, Tokyo Women's Medical College.
Jpn Circ J. 1992 Nov;56(11):1166-71. doi: 10.1253/jcj.56.1166.
Among 366 unstable angina pectoris patients at our hospital, myocardial infarction was common (15.7%) in those with attacks of chest pain lasting for at least 20 min. There was also a high incidence (30.3%) when chest pain continued after the start of inpatient treatment. To investigate the etiology of unstable angina, coronary arteriography was performed in both the unstable and stable stages in these patients and the results were compared. The role of coronary spasm and coronary thrombosis in unstable angina was investigated, and the efficacy of continuous infusion of either diltiazem or isosorbide dinitrate as treatment for these patients was compared. Coronary arteriography in the unstable stage showed, no clear differences in the morphology of the stenotic site and the degree of stenosis between the patients with and without infarcts when urokinase or isosorbide dinitrate were injected into the coronary arteries. When drug treatment was effective, the angina was stabilized without any improvement in the degree of stenosis or the morphology of the involved coronary vessel. Thus, it was difficult to predict the response to treatment from coronary arteriography performed in the unstable stage. Diltiazem was more effective than isosorbide dinitrate, and it appears that some action other than coronary dilatation was involved in achieving the remission of unstable angina.
在我院的366例不稳定型心绞痛患者中，胸痛发作持续至少20分钟的患者发生心肌梗死很常见（15.7%）。住院治疗开始后胸痛仍持续的发生率也很高（30.3%）。为研究不稳定型心绞痛的病因，对这些患者在不稳定期和稳定期均进行了冠状动脉造影，并比较了结果。研究了冠状动脉痉挛和冠状动脉血栓形成在不稳定型心绞痛中的作用，并比较了持续输注地尔硫䓬或硝酸异山梨酯对这些患者的治疗效果。不稳定期冠状动脉造影显示，向冠状动脉内注射尿激酶或硝酸异山梨酯时，有梗死和无梗死患者狭窄部位的形态和狭窄程度无明显差异。当药物治疗有效时，心绞痛得以稳定，但狭窄程度或受累冠状动脉血管的形态并无改善。因此，很难根据不稳定期进行的冠状动脉造影来预测治疗反应。地尔硫䓬比硝酸异山梨酯更有效，而且似乎除冠状动脉扩张外的其他作用参与了不稳定型心绞痛的缓解。
