Bankwala Z, Swenson L J
Section of Cardiology, St Paul-Ramsey Medical Center, MN 55101-2595, USA.
Postgrad Med. 1995 Dec;98(6):155-8, 161-2, 164-5.
Wide variation in severity of unstable angina requires an individualized approach. The goals are to stabilize the patient's condition and prevent progression to acute myocardial infarction or death. The following points summarize the current status of diagnosis and treatment: Patients suspected of having unstable angina but thought to be at low risk can be discharged after clinical evaluation if further outpatient evaluation within 72 hours is scheduled. Patients thought to be at intermediate or high risk should be hospitalized. Thrombolytic therapy should not be administered without evidence of acute myocardial infarction. Assessment of prognosis by noninvasive testing often aids in selection of appropriate therapy. Coronary angiography is appropriate in patients judged to be at high risk for cardiac complications on the basis of their clinical course or results of non-invasive testing. Coronary artery bypass grafting should be recommended in almost all patients with left main coronary artery disease and many with multivessel disease, especially those with left ventricular dysfunction. Percutaneous transluminal coronary angioplasty is also effective in selected patients. The discharge care plan should include continued monitoring of symptoms, appropriate drug therapy (including aspirin), and risk-factor modification.
不稳定型心绞痛严重程度差异很大，需要采取个体化治疗方法。目标是稳定患者病情，防止进展为急性心肌梗死或死亡。以下要点总结了目前的诊断和治疗现状：疑似患有不稳定型心绞痛但被认为风险较低的患者，如果安排在72小时内进行进一步门诊评估，可在临床评估后出院。被认为处于中度或高度风险的患者应住院治疗。无急性心肌梗死证据时不应进行溶栓治疗。通过无创检查评估预后通常有助于选择合适的治疗方法。对于根据临床病程或无创检查结果判断为心脏并发症高风险的患者，冠状动脉造影是合适的。几乎所有左主干冠状动脉疾病患者以及许多多支血管疾病患者，尤其是伴有左心室功能障碍的患者，都应推荐冠状动脉旁路移植术。经皮腔内冠状动脉成形术对选定患者也有效。出院护理计划应包括持续监测症状、适当的药物治疗（包括阿司匹林）以及危险因素修正。
