Weber S, Cattan S, Spaulding C, Degeorges M
Service de cardiologie, hôpital Cochin, Paris.
Arch Mal Coeur Vaiss. 1987 Dec;80 Spec No:81-6.
Although unstable angina is an extremely common and often initial manifestation of coronary disease, few controlled studies of its treatment have been carried out. This relative dearth of information is due to the methodological problems raised by the evaluation of unstable angina. Unlike the definition of myocardial infarction, that of unstable angina--i.e. of a population of coronary patients who from time to time are at a high risk of myocardial infarction or death--is neither unequivocal nor easy to standardize. It follows that the patient population ultimately selected for controlled trials is but a small part of all unstable angina patients. The representativeness of patients involved in therapeutic trials is probably approximate. Moreover, the current criteria for assessment of effectiveness are either the clinical signs of angina in the short term or the incidence of myocardial infarction and changes in survival curves in the mid- and long terms. A more precise definition of criteria of inclusion, leading to an homogeneous population, and the development of a simple and reliable method for detecting and quantifying myocardial ischaemia, both being used as intermediate criteria of assessment, would undoubtedly improve the quality of therapeutic trials in unstable angina and, mostly, their applicability to daily therapeutic practice.
尽管不稳定型心绞痛是冠心病极为常见且往往是首发的临床表现，但针对其治疗的对照研究却很少。信息相对匮乏是由于评估不稳定型心绞痛时出现的方法学问题所致。与心肌梗死的定义不同，不稳定型心绞痛的定义——即一群不时面临心肌梗死或死亡高风险的冠心病患者——既不明确也不易标准化。因此，最终入选对照试验的患者群体只是所有不稳定型心绞痛患者中的一小部分。参与治疗试验的患者代表性可能大致相近。此外，目前的疗效评估标准要么是短期内心绞痛的临床体征，要么是中长期内心肌梗死的发生率以及生存曲线的变化。采用更精确的纳入标准定义以形成同质化群体，并开发一种简单可靠的检测和量化心肌缺血的方法，二者均用作中间评估标准，无疑将提高不稳定型心绞痛治疗试验的质量，而且主要是提高其在日常治疗实践中的适用性。
