Takekoshi N, Murakami E, Nakajima M
Jpn Circ J. 1983 Apr;47(4):495-502. doi: 10.1253/jcj.47.495.
A randomized prospective study was carried out and the therapeutical effects of intensive medical management in the acute stage of unstable angina were compared with those of urgent coronary bypass surgery on patients admitted to Kanazawa Medical University Hospital, who showed an ST elevation or depression during their attacks. Seventy patients with unstable angina were evaluated clinically, angiographically and hemodynamically: 41 of them had a transient ST elevation (26 treated medically; 15 surgically) and 29 had a transient ST depression (15 treated medically; 14 surgically). The hospital mortality rates were 12.2% for the medical group (3.8% in patients with an ST elevation; 26.7% in an ST depression) and 17.2% for the surgical group (6.7% in an ST elevation; 28.6% in an ST depression). These differences were not significant. The incidence of myocardial infarction among in-patients was 7.3% in the medical group (0% in the patients with an ST elevation; 20% in an ST depression) and 13.8% in the surgical group (13.3% in an ST elevation; 14.3% in an ST depression). These differences were also not significant. On their coronary angiograms, single vessel disease was significantly frequent in unstable angina with an ST elevation and so was triple vessel disease in patients with an ST depression. Left ventricular function was markedly improved in patients with an ST elevation after coronary bypass surgery. However, in unstable angina with an ST depression, there was no amelioration of left ventricular contractility and relaxation. It is concluded that by medical or surgical treatment, patients with unstable angina showing an ST elevation during their attacks had a fairly better prognosis than those showing an ST depression; the left ventricular function of the ST elevation group was improved considerably after AC bypass surgery, while those of the ST depression group showed no improvement.
一项随机前瞻性研究得以开展，针对金泽医科大学医院收治的发作时出现ST段抬高或压低的不稳定型心绞痛患者，比较了强化药物治疗在急性期的疗效与急诊冠状动脉搭桥手术的疗效。对70例不稳定型心绞痛患者进行了临床、血管造影和血流动力学评估：其中41例出现短暂ST段抬高（26例接受药物治疗；15例接受手术治疗），29例出现短暂ST段压低（15例接受药物治疗；14例接受手术治疗）。药物治疗组的院内死亡率为12.2%（ST段抬高患者中为3.8%；ST段压低患者中为26.7%），手术治疗组为17.2%（ST段抬高患者中为6.7%；ST段压低患者中为28.6%）。这些差异无统计学意义。住院患者中心肌梗死的发生率在药物治疗组为7.3%（ST段抬高患者中为0%；ST段压低患者中为20%），手术治疗组为13.8%（ST段抬高患者中为13.3%；ST段压低患者中为14.3%）。这些差异也无统计学意义。在冠状动脉造影中，ST段抬高的不稳定型心绞痛患者单支血管病变明显更常见，ST段压低的患者三支血管病变则更常见。冠状动脉搭桥手术后，ST段抬高患者的左心室功能明显改善。然而，在ST段压低的不稳定型心绞痛患者中，左心室收缩和舒张功能并无改善。得出的结论是，通过药物或手术治疗，发作时出现ST段抬高的不稳定型心绞痛患者的预后比出现ST段压低的患者要好得多；ST段抬高组患者在冠状动脉搭桥手术后左心室功能有显著改善，而ST段压低组患者则无改善。
