Day L J, Thibault G E, Sowton E
Br Heart J. 1977 Apr;39(4):363-70. doi: 10.1136/hrt.39.4.363.
Forty-six patients admitted with acute coronary insufficiency are reviewed. All were investigated by coronary angiography; 4 had normal coronary arteries and are included in this study; the remainder had a distribution of coronary artery disease similar to other angina patients. The clinical and angiographic findings, management, and subsequent course of the other 42 patients are presented. Fourteen patients (33%) in whom rest pain persisted after 48 hours underwent emergency coronary angiography, with 3 deaths; of the surviving 11 who had acute saphenous vein bypass grafting, 2 died at operation and 3 had perioperative myocardial infarctions. Seventeen patients (41%) who initially improved required surgery within 6 months because of symptoms. Eleven patients (26%) were not operated on. It is concluded that acute coronary insufficiency is best managed initially by intensive medical therapy but a high proportion will require surgery later because of disabling angina. Early investigation and surgery are associated with a high mortality and incidence of myocardial infarction. Survivors of surgery are symptomatically improved and there is a low incidence of late infarction and death.
对46例因急性冠状动脉供血不足入院的患者进行了回顾性研究。所有患者均接受了冠状动脉造影检查；其中4例冠状动脉正常，纳入本研究；其余患者的冠状动脉疾病分布与其他心绞痛患者相似。本文介绍了另外42例患者的临床和血管造影结果、治疗方法及后续病程。14例（33%）患者在48小时后仍有静息痛，接受了急诊冠状动脉造影，其中3例死亡；在存活的11例行急性大隐静脉搭桥术的患者中，2例在手术中死亡，3例发生围手术期心肌梗死。17例（41%）最初病情改善的患者因症状在6个月内需要手术治疗。11例（26%）患者未接受手术。结论是，急性冠状动脉供血不足最初最好采用强化药物治疗，但由于致残性心绞痛，很大一部分患者后期仍需要手术。早期检查和手术与高死亡率和心肌梗死发生率相关。手术幸存者症状改善，晚期梗死和死亡发生率较低。
