Borzak S, Verter J, Bajwa H S, Lesch M
Henry Ford Heart & Vascular Institute, Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI 48202.
Clin Cardiol. 1993 Sep;16(9):637-42. doi: 10.1002/clc.4960160903.
Thrombolytic therapy for unstable angina has not gained acceptance as a primary treatment for unstable angina (UA) despite the evidence showing a reduction in mortality when these agents are given for myocardial infarction. The purpose of this review is to examine the clinical value of thrombolytic therapy for UA. The multiple lines of evidence supporting intracoronary thrombus formation as a key mechanism in the pathogenesis of UA are reviewed. Studies examining the effect of thrombolytic therapy on angiographic endpoints have shown little effect on the extent of luminal narrowing, but do reveal a decrease in angiographically detected thrombus. Twelve randomized, controlled trials of thrombolytic agents in 611 UA patients with predefined clinical endpoints have been published. These trials varied widely in design and adjunctive therapy both in treated and control grops. Review of these trials show a tendency to fewer clinical events such as death, infarction, and need for revascularization in treated patients, with a corresponding increase in bleeding complications. Clinical efficacy of thrombolytic therapy cannot be excluded by the available data, perhaps in part because of insufficient numbers of patients treated. Determination of the net clinical value of thrombolytic therapy must await larger and more definitive trials.
尽管有证据表明，在心肌梗死时使用这些药物可降低死亡率，但溶栓疗法尚未被广泛接受为不稳定型心绞痛（UA）的主要治疗方法。本综述的目的是探讨溶栓疗法对UA的临床价值。本文回顾了支持冠状动脉内血栓形成是UA发病机制关键环节的多条证据。研究溶栓疗法对血管造影终点影响的研究表明，其对管腔狭窄程度影响不大，但确实显示血管造影检测到的血栓有所减少。已发表了12项针对611例有预定义临床终点的UA患者进行溶栓药物的随机对照试验。这些试验在治疗组和对照组的设计及辅助治疗方面差异很大。对这些试验的综述表明，治疗组患者发生死亡、梗死和需要血管重建等临床事件的趋势减少，而出血并发症相应增加。现有数据不能排除溶栓疗法的临床疗效，这可能部分是由于治疗的患者数量不足。溶栓疗法净临床价值的确定必须等待更大规模、更明确的试验。
