Scott S M, Luchi R J, Deupree R H
Veterans Administration Medical Center, Asheville, NC 28805.
Circulation. 1988 Sep;78(3 Pt 2):I113-21.
In a prospective randomized trial, 468 patients with unstable angina pectoris who were stratified according to clinical presentation (Type I or Type II angina) and left ventricular function (normal or abnormal) were assigned to medical or surgical treatment groups. Left ventricular function was defined as abnormal if the ejection fraction was less than 0.50, or if the end-diastolic pressure was 16 mm Hg or greater. Left ventricular function was abnormal in 134 patients, 66 of whom were assigned to surgical and 68 to medical treatment groups. The cumulative 3-year mortality for surgical patients was 6.1% and for medical patients, 17.6% (p = 0.039). This 3-year figure represents a 65% reduction in mortality with surgery. Survival was significantly better for surgical patients whose ejection fractions ranged from 0.30 to 0.49 (p = 0.05). Survival of patients whose ejection fractions were greater than 0.69 was better with medical treatment (p = 0.049). Thus, surgery appears to be the treatment of choice for patients with unstable angina pectoris and abnormal left ventricular function.
在一项前瞻性随机试验中，468例不稳定型心绞痛患者根据临床表现（I型或II型心绞痛）和左心室功能（正常或异常）进行分层，然后被分配到药物治疗组或手术治疗组。如果射血分数小于0.50，或舒张末期压力为16毫米汞柱或更高，则左心室功能被定义为异常。134例患者左心室功能异常，其中66例被分配到手术治疗组，68例被分配到药物治疗组。手术患者的3年累积死亡率为6.1%，药物治疗患者为17.6%（p = 0.039）。这个3年的数据表明手术可使死亡率降低65%。射血分数在0.30至0.49之间的手术患者生存率显著更高（p = 0.05）。射血分数大于0.69的患者药物治疗的生存率更好（p = 0.049）。因此，对于不稳定型心绞痛且左心室功能异常的患者，手术似乎是首选治疗方法。
