Siegel W C, Mark D B, Hlatky M A, Harrell F E, Pryor D B, Barefoot J C, Williams R B
Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710.
Am J Cardiol. 1989 Dec 1;64(19):1280-3. doi: 10.1016/0002-9149(89)90568-7.
Type A patients with coronary artery disease (CAD) tend to ignore or underreport symptoms, especially during challenging tasks such as the treadmill exercise test. To determine whether type A CAD patients might be more likely than type B patients to have silent ischemia during exercise and consequently a worse prognosis, 403 patients with stable CAD who had significant coronary disease on angiography, a positive Bruce protocol treadmill test and a structured interview to assess type A behavior were studied. Median follow-up time was 6 years. Type A patients were more likely to experience silent ischemia during exercise than were type B patients (35 vs 25%, p = 0.05). Patients with silent ischemia during exercise had a history of fewer anginal episodes/week, and type A patients with silent ischemia were less likely to have had a history of typical angina. However, using the Cox model, there were no significant differences in survival between type A patients and B patients with silent ischemia (4-year survival 86 vs 79%, p = 0.44) and no significant differences in survival between type A patients with silent ischemia and type A patients with symptomatic ischemia (6-year survival 86 vs 80%, p = 0.59). Similar results were obtained for infarction-free survival. Type A patients are more likely than type B patients to have silent ischemia during exercise, but long-term survival is not affected.
A型冠心病（CAD）患者往往会忽视或少报症状，尤其是在诸如跑步机运动试验等具有挑战性的任务期间。为了确定A型CAD患者在运动期间发生无症状性心肌缺血的可能性是否比B型患者更高，进而判断其预后是否更差，对403例稳定型CAD患者进行了研究，这些患者在血管造影检查中显示有严重冠状动脉疾病、布鲁斯方案跑步机试验结果为阳性，并且通过结构化访谈评估了A型行为。中位随访时间为6年。与B型患者相比，A型患者在运动期间更易发生无症状性心肌缺血（35%对25%，p = 0.05）。运动期间发生无症状性心肌缺血的患者每周心绞痛发作次数较少，且发生无症状性心肌缺血的A型患者既往有典型心绞痛病史的可能性较小。然而，使用Cox模型分析，有无症状性心肌缺血的A型患者与B型患者在生存率方面无显著差异（4年生存率86%对79%，p = 0.44），有无症状性心肌缺血的A型患者与有症状性心肌缺血的A型患者在生存率方面也无显著差异（6年生存率86%对80%，p = 0.59）。在无梗死生存率方面也得到了类似结果。A型患者在运动期间比B型患者更易发生无症状性心肌缺血，但长期生存率不受影响。
