Holdright D, Patel D, Cunningham D, Thomas R, Hubbard W, Hendry G, Sutton G, Fox K
Royal Brompton National Heart and Lung Hospital, London, United Kingdom.
J Am Coll Cardiol. 1994 Jul;24(1):39-45. doi: 10.1016/0735-1097(94)90539-8.
This study compared the effects of heparin and aspirin versus aspirin alone on transient myocardial ischemia and in-hospital prognosis in patients with unstable angina.
Transient myocardial ischemia occurring in patients with unstable angina is associated with an adverse prognosis. Heparin and aspirin are two drugs used frequently in the treatment of this condition, but the effect of combination therapy versus aspirin alone on transient myocardial ischemia is unknown.
Two hundred eighty-five consecutive patients with unstable angina were randomized to receive either intravenous heparin plus oral aspirin (150 mg once daily) (Group H + A) or aspirin alone (Group A). Patients also received a beta-adrenergic blocking agent, diltiazem and intravenous nitrates. ST segment monitoring was performed for the 1st 48 h of treatment. Patients were followed up for the duration of their in-hospital stay.
One hundred fifty-four patients (30 women, mean [+/- SEM] age 58.3 +/- 0.8 years) received heparin and aspirin (Group H + A), and 131 patients (26 women, mean age 60.6 +/- 0.8 years) received aspirin only (Group A). ST segment monitoring (11,622 h) yielded 244 episodes of transient myocardial ischemia of a total duration of 7,819 min. There were no significant differences between the two treatment arms in the number of patients with transient myocardial ischemia (27 [18%] in Group H + A vs. 31 [24%] in Group A), number of episodes (96 in Group H + A vs. 148 in Group A) or total duration of transient myocardial ischemia (2,911 min in Group H + A vs. 4,908 min in Group A). The incidence of in-hospital myocardial infarction or death was significantly higher in patients with transient myocardial ischemia (53% vs. 22%, p < 0.0001). Five of the six deaths occurred in patients with transient myocardial ischemia. Event-free survival from myocardial infarction or death was similar in both treatment groups. Preadmission therapy with aspirin was associated with a lower in-hospital infarction rate (19% vs. 34%, p = 0.01).
The presence of transient myocardial ischemia in patients with unstable angina is associated with a significantly higher incidence of myocardial infarction or death in hospital. Combined therapy with heparin and aspirin compared with aspirin alone makes no difference in the development of these events, nor does it reduce the development of transient myocardial ischemia.
本研究比较了肝素与阿司匹林联合用药和单用阿司匹林对不稳定型心绞痛患者短暂性心肌缺血及住院预后的影响。
不稳定型心绞痛患者发生的短暂性心肌缺血与不良预后相关。肝素和阿司匹林是治疗该疾病常用的两种药物，但联合治疗与单用阿司匹林对短暂性心肌缺血的影响尚不清楚。
285例连续的不稳定型心绞痛患者被随机分为两组，分别接受静脉注射肝素加口服阿司匹林（150mg，每日1次）（H+A组）或单用阿司匹林（A组）。患者还接受了β-肾上腺素能阻滞剂、地尔硫䓬和静脉硝酸酯类药物治疗。在治疗的前48小时进行ST段监测。对患者进行住院期间的随访。
154例患者（30例女性，平均[±标准误]年龄58.3±0.8岁）接受肝素和阿司匹林治疗（H+A组），131例患者（26例女性，平均年龄60.6±0.8岁）仅接受阿司匹林治疗（A组）。ST段监测（11622小时）共发现244次短暂性心肌缺血发作，总时长7819分钟。两组在短暂性心肌缺血患者数量（H+A组27例[18%] vs. A组31例[24%]）、发作次数（H+A组96次 vs. A组148次）或短暂性心肌缺血总时长（H+A组2911分钟 vs. A组4908分钟）方面无显著差异。短暂性心肌缺血患者的住院心肌梗死或死亡发生率显著更高（53% vs. 22%，p<0.0001）。6例死亡患者中有5例发生在短暂性心肌缺血患者中。两个治疗组心肌梗死或死亡的无事件生存率相似。入院前使用阿司匹林治疗与较低的住院梗死率相关（19% vs. 34%，p=0.01）。
不稳定型心绞痛患者出现短暂性心肌缺血与住院期间心肌梗死或死亡的发生率显著升高相关。肝素与阿司匹林联合治疗与单用阿司匹林相比，在这些事件的发生方面无差异，也不能减少短暂性心肌缺血的发生。
