Steinhubl S R, Moliterno D J
Department of Cardiology, Cleveland Clinic Foundation, OH 44195, USA.
Heart Vessels. 1997;Suppl 12:148-55.
Unstable angina and non-Q-wave myocardial infarction, part of the acute coronary syndromes, are characterized by coronary arterial plaque rupture and endovascular thrombus formation. Plaque rupture leads to exposure of subendothelial components such as collagen and fibronectin, and these substances are known to cause platelet activation, aggregation, and initiation of the coagulation cascade. Aspirin and heparin have been used as therapeutic mainstays for acute coronary syndromes, acting as antiplatelet and antithrombin agents, respectively. Despite treatment with this conventional anticoagulant strategy and antianginal drugs, substantial morbidity and mortality continue to be associated with unstable angina and non-Q-wave myocardial infarction. Specific antagonists of the platelet glycoprotein IIb/IIIa inhibitor have proved effective in substantially reducing ischemic events following percutaneous coronary revascularization, and several trials using these agents in acute coronary syndromes are now completed. Compared to patients receiving standard therapy (aspirin and heparin), platelet IIb/IIIa antagonists have further reduced the incidence of major ischemic events. Ongoing studies are addressing the optimal extent and duration of platelet inhibition in patients with acute coronary syndromes.
不稳定型心绞痛和非Q波心肌梗死是急性冠状动脉综合征的一部分，其特征是冠状动脉斑块破裂和血管内血栓形成。斑块破裂导致内皮下成分如胶原蛋白和纤连蛋白暴露，已知这些物质会引起血小板活化、聚集并启动凝血级联反应。阿司匹林和肝素一直作为急性冠状动脉综合征的主要治疗药物，分别作为抗血小板和抗凝血酶药物。尽管采用了这种传统的抗凝策略和抗心绞痛药物治疗，但不稳定型心绞痛和非Q波心肌梗死仍伴有大量的发病率和死亡率。血小板糖蛋白IIb/IIIa抑制剂的特异性拮抗剂已被证明在经皮冠状动脉血运重建后能有效大幅减少缺血事件，目前已有多项在急性冠状动脉综合征中使用这些药物的试验完成。与接受标准治疗（阿司匹林和肝素）的患者相比，血小板IIb/IIIa拮抗剂进一步降低了主要缺血事件的发生率。正在进行的研究正在探讨急性冠状动脉综合征患者血小板抑制的最佳程度和持续时间。
