Cohn P F
Department of Medicine, State University of New York Health Sciences Center, Stony Brook 11794.
Am J Med. 1989 Jan 16;86(1A):6-8. doi: 10.1016/0002-9343(89)90003-x.
Patients with silent myocardial ischemia can be classified as one of three clinical types: those who are totally asymptomatic (type 1), those who are asymptomatic after a myocardial infarction (type 2), and those who demonstrate both asymptomatic and symptomatic episodes (type 3). Total ischemic activity may be similar in any given patient, but the ratio of symptomatic to asymptomatic episodes will differ. Prognosis appears dependent on the degree of total ischemic activity plus the extent of coronary artery disease and left ventricular dysfunction. The effects of therapy can be monitored with exercise testing and/or Holter monitoring. Using the latter technique, the largest multicenter study to date, the Nifedipine Total Ischemia Awareness Program, has demonstrated the advantages of adding a calcium antagonist to nitrate and/or beta-blocker therapy regimens in order to maximize the reduction in total ischemic activity in angina patients.
完全无症状者（1型）、心肌梗死后无症状者（2型）以及既有无症状发作又有症状发作的患者（3型）。在任何给定患者中，总的缺血活动可能相似，但有症状发作与无症状发作的比例会有所不同。预后似乎取决于总的缺血活动程度、冠状动脉疾病的范围以及左心室功能障碍。可通过运动试验和/或动态心电图监测来监测治疗效果。运用后一种技术，即迄今为止规模最大的多中心研究——硝苯地平总缺血意识项目，已证明在硝酸酯类和/或β受体阻滞剂治疗方案中加用钙拮抗剂的优势，以便最大程度降低心绞痛患者的总缺血活动。
