Blaustein A S, Heller G V, Kolman B S
Am J Cardiol. 1983 Nov 1;52(8):950-4. doi: 10.1016/0002-9149(83)90510-6.
Patients with unstable angina pectoris who remain symptomatic at rest after hospitalization are at increased risk of death or myocardial infarction. This report presents the results of adding the calcium influx blocking agent nifedipine to aggressive therapy with nitrates and beta-blocking drugs in 47 hospitalized patients. The patients were followed up for an average of 12 months. Twenty-two (47%) improved sufficiently to be discharged; despite this symptomatic improvement, 8 had cardiac events within 4 months. Eighteen patients had no symptomatic improvement and 7 of them had cardiac events in 4 months. In 7 others, relief was insufficient to permit discharge, and 1 of these patients had myocardial infarction. In all, 31 patients were treated with medical therapy only. Twenty-one of these patients had a favorable short-term response to nifedipine; 13 died or had an infarction in less than 4 months. Two of 16 patients who underwent coronary artery bypass surgery had cardiac events. The presence of electrocardiographic changes with pain did not identify either a group at higher risk or a group with a better outcome with nifedipine. We conclude that in a high-risk subset of patients with unstable angina pectoris, nifedipine does not reduce morbidity or mortality or the need for bypass surgery, but relieves symptoms in many patients. An early symptomatic response to nifedipine did not predict a reduced incidence of subsequent cardiac events.
不稳定型心绞痛患者在住院后静息时仍有症状，其死亡或心肌梗死风险增加。本报告介绍了在47例住院患者中，在使用硝酸盐和β受体阻滞剂进行积极治疗的基础上加用钙内流阻滞剂硝苯地平的结果。患者平均随访12个月。22例（47%）症状改善到足以出院；尽管有症状改善，但8例在4个月内发生了心脏事件。18例患者症状未改善，其中7例在4个月内发生了心脏事件。另外7例患者症状缓解不足以出院，其中1例发生了心肌梗死。总共有31例患者仅接受药物治疗。这些患者中有21例对硝苯地平有良好的短期反应；13例在不到4个月内死亡或发生梗死。16例行冠状动脉搭桥手术的患者中有2例发生了心脏事件。疼痛时心电图改变的存在既不能确定硝苯地平治疗风险较高的组，也不能确定预后较好的组。我们得出结论，在不稳定型心绞痛的高危亚组患者中，硝苯地平并不能降低发病率、死亡率或减少搭桥手术的需求，但能缓解许多患者的症状。对硝苯地平的早期症状反应并不能预测随后心脏事件的发生率降低。
