Selden R, Neill W A, Ritzmann L W, Okies J E, Anderson R P
N Engl J Med. 1975 Dec 25;293(26):1329-33. doi: 10.1056/NEJM197512252932601.
Forty patients with acute coronary insufficiency, including continued angina at rest and reversible ischemic electrocardiographic changes after hospitalization ("high-risk" subgroup), were randomly allotted to medical therapy or urgent surgical coronary bypass groups. In four months there were no deaths and two myocardial infarctions in 19 medical patients and one death and three myocardial infarctions in 21 surgical patients. Left ventricular ejection fraction did not change significantly in either group. The surgical patients had significantly higher functional capacities at four months as judged by lower symptomatic functional class (P less than 0.01), higher exercise angina threshold (P less than 0.001), higher pacing angina threshold (P less than 0.0001), and higher myocardial lactate extraction during pacing (P less than 0.0001). Initial medical management of patients with acute coronary insufficiency followed by elective coronary bypass in patients with continued disabling angina pectoris is a reasonable alternative to emergency bypass.
40例急性冠状动脉功能不全患者，包括静息时持续性心绞痛以及住院后可逆性缺血性心电图改变（“高危”亚组），被随机分配至药物治疗组或紧急外科冠状动脉搭桥组。在4个月的时间里，19例接受药物治疗的患者无死亡病例，发生2例心肌梗死；21例接受外科手术的患者有1例死亡，发生3例心肌梗死。两组患者的左心室射血分数均无显著变化。根据症状功能分级较低（P<0.01）、运动性心绞痛阈值较高（P<0.001）、起搏性心绞痛阈值较高（P<0.0001）以及起搏期间心肌乳酸摄取较高（P<0.0001）判断，外科手术患者在4个月时的功能能力显著更高。对于急性冠状动脉功能不全患者，先进行初始药物治疗，然后对持续性致残性心绞痛患者进行择期冠状动脉搭桥手术，是紧急搭桥手术的合理替代方案。
