Sclarovsky S, Davidson E, Lewin R F, Strasberg B, Arditti A, Agmon J
Am Heart J. 1986 Sep;112(3):459-62. doi: 10.1016/0002-8703(86)90506-5.
We retrospectively evaluated 32 patients with unstable angina (UA) and no evidence of increased oxygen demand during episodes of chest pain (no significant changes in heart rate and blood pressure), who developed an acute myocardial infarction (AMI) during the same hospitalization. Based on the type of ST changes during anginal pain, two groups were defined: Group A included 19 patients who developed ST elevation during AMI; 15 of these 19 patients (79%) were in Killip class I, two were in class II, and there was one patient each in classes III and IV, respectively. Only one of the 19 patients died. Group B included 13 patients who developed ST depression during AMI; nine of these 13 patients were in Killip class IV and the remaining four patients died before they could be evaluated. Ten patients died (77%) (p less than 0.01), seven in electromechanical dissociation and three in cardiogenic shock. Postmortem examination, performed in four patients, revealed total obstruction of the left main coronary artery. It is concluded that patients with UA who, during attacks of chest pain, develop ST depression and no evidence of increased oxygen demand may have a poor prognosis when they develop an AMI. This selected group of high-risk patients appears to need immediate intensive medical care and most probably early surgical treatment.
我们回顾性评估了32例不稳定型心绞痛（UA）患者，这些患者在胸痛发作期间无氧需求增加的证据（心率和血压无显著变化），且在同一住院期间发生了急性心肌梗死（AMI）。根据心绞痛发作时ST段改变的类型，将患者分为两组：A组包括19例在AMI期间出现ST段抬高的患者；这19例患者中，15例（79%）为Killip I级，2例为II级，III级和IV级各有1例。19例患者中仅1例死亡。B组包括13例在AMI期间出现ST段压低的患者；这13例患者中，9例为Killip IV级，其余4例在能够进行评估前死亡。10例患者死亡（77%）（p<0.01），7例死于电机械分离，3例死于心源性休克。对4例患者进行了尸检，结果显示左主干冠状动脉完全阻塞。结论是，UA患者在胸痛发作时出现ST段压低且无氧需求增加证据，发生AMI时预后可能较差。这群选定的高危患者似乎需要立即接受强化医疗护理，很可能还需要早期手术治疗。
