Neill W A
J Lab Clin Med. 1985 Mar;105(3):390-6.
Twenty-four of 96 patients with unstable angina exhibited transient ST-T abnormalities in anterior electrocardiographic leads at rest combined with severe subtotal stenosis (80% to 95% narrowing) of the proximal left anterior descending artery (LAD). This entity is termed staccato LAD occlusion to signify the probable pathophysiology responsible for the patients' repeated episodes of ischemic cardiac angina. Although staccato LAD occlusion represents a minority of patients hospitalized with unstable angina, it includes most who suffer cardiac complications. Among patients treated medically, 10 of 16 with staccato LAD occlusion developed anterior myocardial infarction, whereas cardiac complications occurred in only three of the remaining 50 patients with unstable angina during the 4-month follow-up period (p less than 0.001). Medical treatment of staccato LAD occlusion should be directed primarily against coronary occlusion. Considering the high risk of myocardial infarction, until reliable methods for preventing the threatened occlusion are demonstrated, urgent coronary bypass surgery seems warranted for these patients.
96例不稳定型心绞痛患者中有24例在静息时心电图前壁导联出现短暂ST-T异常，同时左前降支近端严重次全狭窄（狭窄80%至95%）。这种情况被称为间歇性左前降支闭塞，以表明导致患者反复发生缺血性心绞痛的可能病理生理机制。尽管间歇性左前降支闭塞在因不稳定型心绞痛住院的患者中占少数，但其中大多数会出现心脏并发症。在接受药物治疗的患者中，16例间歇性左前降支闭塞患者中有10例发生前壁心肌梗死，而在4个月的随访期内，其余50例不稳定型心绞痛患者中只有3例出现心脏并发症（p<0.001）。间歇性左前降支闭塞的药物治疗应主要针对冠状动脉闭塞。鉴于心肌梗死的高风险，在证明有可靠的方法预防即将发生的闭塞之前，对于这些患者，紧急冠状动脉搭桥手术似乎是必要的。
