Severi S, Orsini E, Marraccini P, Michelassi C, L'Abbate A
C.N.R. Institute of Clinical Physiology, University of Pisa, Italy.
Eur Heart J. 1988 Apr;9(4):441-6. doi: 10.1093/oxfordjournals.eurheartj.a062522.
The purpose of this study was to evaluate the prognostic usefulness of basal electrocardiogram and exercise stress test in 374 patients with unstable angina submitted to coronary angiography during the same hospitalization period. After stabilization of symptoms by medical therapy, patients were subdivided into four groups according to the ECG and stress test: Group 1 (54 patients with normal ECG and exercise stress test negative for ischaemia); Group 2 (86 patients with normal ECG and exercise stress test positive for ischaemia); Group 3 (59 patients with abnormal ECG and exercise stress test negative for ischaemia); Group 4 (175 patients with abnormal ECG and exercise stress test positive for ischaemia). The severity of coronary atherosclerosis and impairment of left ventricular function increased progressively from Group 1 to 4, although differences in ventricular function were not significant between Groups 2 and 3. When discharged, patients were treated with verapamil and nitrates and followed for a period ranging from 1 to 8 years; during follow-up, only one patient of Group 1 underwent coronary bypass surgery, compared to 22, 7 and 46 patients in Groups 2, 3 and 4, respectively. The eight-year survival rate in the four groups (1-4) was 100%, 97%, 88% and 70%, respectively. Statistically significant differences were observed between Groups 1 and 3, 1 and 4, 2 and 4, and 3 and 4. Thus, the ECG and exercise stress test allow a population of patients with unstable angina to be selected (Group 1), having excellent long-term prognosis. These patients could avoid angiography, thereby reducing hospital costs, without compromising their health.
本研究的目的是评估基础心电图和运动负荷试验对374例在同一住院期间接受冠状动脉造影的不稳定型心绞痛患者的预后价值。在通过药物治疗使症状稳定后，根据心电图和负荷试验将患者分为四组：第1组（54例心电图正常且运动负荷试验缺血阴性的患者）；第2组（86例心电图正常但运动负荷试验缺血阳性的患者）；第3组（59例心电图异常且运动负荷试验缺血阴性的患者）；第4组（175例心电图异常且运动负荷试验缺血阳性的患者）。冠状动脉粥样硬化的严重程度和左心室功能损害从第1组到第4组逐渐增加，尽管第2组和第3组之间的心室功能差异不显著。出院时，患者接受维拉帕米和硝酸盐治疗，并随访1至8年；在随访期间，第1组只有1例患者接受了冠状动脉搭桥手术，而第2组、第3组和第4组分别有22例、7例和46例。四组（1至4组）的八年生存率分别为100%、97%、88%和70%。在第1组和第3组、第1组和第4组、第2组和第4组以及第3组和第4组之间观察到统计学上的显著差异。因此，心电图和运动负荷试验可以筛选出一组具有良好长期预后的不稳定型心绞痛患者（第1组）。这些患者可以避免进行血管造影，从而降低住院费用，而不会损害他们的健康。
