Bertel O
Schweiz Med Wochenschr Suppl. 1984;16:24-9.
Despite the recent advances in cardiac intensive care, which have reduced hospital mortality for acute myocardial infarction to below 15%, a substantial decline in overall mortality from myocardial infarction has not been achieved by these therapeutic measures. More effective management of patients with advanced coronary heart disease would include better detection of high risk subgroups, especially of patients with unstable angina, better treatment with rapid adjustment of doses and combination of anti-anginal drugs, and better organisation of medical care in order to reduce hospitalisation delay in patients with impending or suspected myocardial infarction and avoid unnecessary hospital admissions in those with effort angina responsive to medical treatment. We propose a treatment scheme for unstable angina which, for out-patients with recent onset or crescendo angina on effort, is based on betablockers combined with calcium channel blockers and long-acting nitrates as second and third step respectively. In every case an anti-platelet aggregating agent should be added. If medical treatment fails to abolish the ischemic symptoms within days, surgical treatment should be considered.
尽管近期心脏重症监护取得了进展，已将急性心肌梗死的医院死亡率降至15%以下，但这些治疗措施尚未使心肌梗死的总体死亡率大幅下降。对晚期冠心病患者进行更有效的管理将包括更好地检测高危亚组，尤其是不稳定型心绞痛患者，通过快速调整剂量和联合使用抗心绞痛药物进行更好的治疗，以及更好地组织医疗护理，以减少即将发生或疑似心肌梗死患者的住院延迟，并避免对药物治疗有效的劳力性心绞痛患者进行不必要的住院治疗。我们提出了一种不稳定型心绞痛的治疗方案，对于近期发作或劳力性进行性加重心绞痛的门诊患者，该方案分别以β受体阻滞剂联合钙通道阻滞剂和长效硝酸盐作为第二步和第三步治疗。在每种情况下，均应添加抗血小板聚集剂。如果药物治疗在数天内未能消除缺血症状，则应考虑手术治疗。
