Hultgren H N, Pfeifer J F, Angell W W, Lipton M J, Bilisoly J
Am J Cardiol. 1977 May 4;39(5):734-40. doi: 10.1016/s0002-9149(77)80137-9.
Medical versus surgical treatment of unstable angina was compared in a prospective nonrandomized study of 118 patients. Acute transient ST-T wave changes were present during chest pain in all patients. Acute infarction was excluded by serial electrocardiograms and enzyme studies. All patients admitted to the coronary care unit from 1970 to 1975 who fulfilled the entry criteria were included in the study. The starting point for data evaluation was 5 days after hospital admission. Characteristics at entry were similar in 66 medically treated patients and 52 patients who had coronary bypass vein graft surgery. During a mean follow-up period of 23 months in 66 medically treated patients with unstable angina the incidence rate of nonfatal myocardial infarction was 17% and the total mortality rate 21 percent compared with respective rates of 19% and 5.8% in 52 surgically treated patients. In the surgical group 8 patients (15%) had a perioperative infarction and only 2 (4%) had a late infarction; one patient (2%) died at operation. Symptomatic improvement was observed more frequently in the surgically treated group. Sixty percent of surgically treated patients were free of angina compared with 21% of medically treated patients. Eight medically treated patients (12%) required late surgical treatment for persistent severe angina despite optimal medical management.
在一项对118例患者进行的前瞻性非随机研究中，对不稳定型心绞痛的内科治疗与外科治疗进行了比较。所有患者在胸痛发作时均出现急性短暂性ST-T波改变。通过系列心电图和酶学检查排除了急性心肌梗死。1970年至1975年期间入住冠心病监护病房且符合入选标准的所有患者均纳入研究。数据评估的起始点为入院后5天。66例接受内科治疗的患者和52例接受冠状动脉搭桥静脉移植手术的患者在入院时的特征相似。在66例接受内科治疗的不稳定型心绞痛患者平均23个月的随访期内，非致命性心肌梗死的发生率为17%，总死亡率为21%，相比之下，52例接受外科治疗的患者相应的发生率分别为19%和5.8%。在外科治疗组中，8例患者（15%）发生围手术期心肌梗死，只有2例（4%）发生晚期心肌梗死；1例患者（2%）在手术中死亡。在接受外科治疗的组中，症状改善更为常见。60%接受外科治疗的患者无心绞痛，而接受内科治疗的患者这一比例为21%。8例接受内科治疗的患者（12%）尽管接受了最佳内科治疗，但因持续性严重心绞痛需要晚期外科治疗。
