Bertolasi C A, Tronge J E, Mon G A, Turri D, Lugones M I
Clin Cardiol. 1979 Apr;2(2):113-20. doi: 10.1002/clc.4960020205.
In order to determine the natural evolution of different clinical types of "unstable angina", 167 patients were included in a prospective study. After angiography, 11 (6.5%) were excluded because they had no significant coronary lesions. The remaining 156 were sorted into different groups according to their clinical characteristics and were followed up for a period of 24 months at least. After that follow-up period, mortality and incidence of acute myocardial infarction (AMI) were as follows: angina of recent onset (Class III--IV NYHA): 8.5% (3/35) and 34.2% (12/35). Progressive angina: 7.4% (2/27) and 7.4% (2/27). Intermediate syndrome: 41.6% (10/24) and 37.5% (9/24). Prinzmetal's angina: 10% (1/10) and 10% (1/10). Post acute myocardial infarction angina: 35% (7/20) and 10% (2/20). Acute persistent ischemia: 2.5% (1/40) and 20% (8/40). Comparison of these figures pointed out significant differences (p less than 0.001 for mortality and p less than 0.03 for AMI incidence respectively). We conclude that it is clinically possible to identify different groups within the so-called unstable angina. Such a division not only allows for the creation of more homogeneous groups, but it contributes to a more rational therapeutic approach and also permits identification of high risk prodromes of greater complications, such as myocardial infarction or sudden death.
为了确定不同临床类型“不稳定型心绞痛”的自然演变过程，167例患者被纳入一项前瞻性研究。血管造影后，11例（6.5%）因无明显冠状动脉病变被排除。其余156例根据其临床特征分为不同组，并至少随访24个月。在该随访期后，急性心肌梗死（AMI）的死亡率和发生率如下：近期发作性心绞痛（NYHA III-IV级）：8.5%（3/35）和34.2%（12/35）。进行性心绞痛：7.4%（2/27）和7.4%（2/27）。中间综合征：41.6%（10/24）和37.5%（9/24）。变异型心绞痛：10%（1/10）和10%（1/10）。急性心肌梗死后心绞痛：35%（7/20）和10%（2/20）。急性持续性缺血：2.5%（1/40）和20%（8/40）。这些数据的比较指出了显著差异（死亡率p<0.001，AMI发生率p<0.03）。我们得出结论，在所谓的不稳定型心绞痛中从临床上识别不同组是可行的。这样的划分不仅有助于创建更同质的组，而且有助于采取更合理的治疗方法，还能识别出更高风险的前驱症状，如心肌梗死或猝死等更严重的并发症。
