Pepine C J, Hill J A
Am J Cardiol. 1987 Mar 9;59(7):7C-12C. doi: 10.1016/0002-9149(87)90189-5.
Recent reports suggest that neither the severity nor control of angina influences prognosis in patients with coronary heart disease. One possible explanation for such findings is that episodes of angina are only a small fraction of the daily ischemic episodes occurring in these patients. Silent episodes represent most of the ischemic burden in many patients with coronary disease who have positive exercise test results despite the absence of pain. Silent episodes also represent most of the ischemic burden in patients with either stable or unstable angina. Since silent episodes may have prognostic significance, a major goal of therapy should be the modification of both silent and painful ischemic episodes. Currently available pharmacotherapy has the potential to reduce the total ischemic burden caused by both painful and painless attacks and, thereby, alter prognosis.
近期报告显示，心绞痛的严重程度和控制情况均不影响冠心病患者的预后。对此类发现的一种可能解释是，心绞痛发作仅占这些患者每日缺血发作的一小部分。在许多运动试验结果呈阳性但无疼痛症状的冠心病患者中，无症状发作占缺血负荷的大部分。无症状发作在稳定型或不稳定型心绞痛患者中也占缺血负荷的大部分。由于无症状发作可能具有预后意义，治疗的一个主要目标应是改变无症状和有症状的缺血发作。目前可用的药物治疗有可能减轻由疼痛性和无痛性发作引起的总缺血负荷，从而改变预后。
