Ferrero V, Steffenino G, Meinardi F, Conte E, Deorsola A, Vado A, Racca E, Dellavalle A, Ribichini F, Menardi E, Uslenghi E
Divisione di Cardiologia, Azienda Ospedaliera Santa Croce e Carle, Cuneo.
G Ital Cardiol. 1998 Feb;28(2):112-9.
The early invasive diagnostic approach with extensive use of myocardial revascularization in patients with unstable angina is a matter of debate. Both the advantages of this strategy and the choice of the best candidates are controversial. The widespread applicability of this approach in Italian hospitals is also questionable, due to limited availability of facilities for interventional cardiology.
A prospective, observational study was done on a cohort of consecutive patients, who were admitted with a diagnosis of unstable angina and treated with an early aggressive approach at a center with interventional cardiology facilities without cardiac surgery. The aim of the study was to evaluate both the immediate and long-term clinical outcome of patients and the efficiency of our therapeutic approach.
Two-hundred and two patients were enrolled and 85% were in Braunwald class III. Coronary angiography was performed in 171 patients (85%) at 2.1 +/- 2.4 days after admission: it showed one-, two- and three-vessel disease in 40, 29 and 22% of cases, respectively; 9% of patients had no severe coronary lesion. Left ventricular ejection fraction was 0.58 +/- 0.13. Medical treatment, coronary by-pass surgery and percutaneous myocardial revascularization were chosen in 36, 24 and 40% of cases, respectively. Coronary angioplasty was performed in our center in 58 (73%) of 80 patients at 6.8 +/- 5.6 days after admission and stents were used in 42 cases (74%). Overall hospital stay was 10.4 +/- 4 days. Cumulated adverse events (death and non-fatal myocardial infarction) occurred in 2.5 and 7% of patients during the initial admission and in the following year, respectively.
An early aggressive approach to patients with unstable angina is feasible in a hospital with interventional cardiology in the absence of cardiac surgical facilities. The immediate favorable clinical results of this strategy in an intermediate-risk cohort seem to persist at one-year follow-up.
在不稳定型心绞痛患者中广泛采用心肌血运重建的早期侵入性诊断方法存在争议。该策略的优势以及最佳候选者的选择都存在争议。由于介入心脏病学设施有限，这种方法在意大利医院的广泛适用性也值得怀疑。
对一组连续的患者进行了一项前瞻性观察研究，这些患者被诊断为不稳定型心绞痛，并在一家有介入心脏病学设施但无心脏外科手术的中心接受早期积极治疗。该研究的目的是评估患者的近期和长期临床结局以及我们治疗方法的有效性。
共纳入202例患者，85%为Braunwald III级。171例患者（85%）在入院后2.1±2.4天进行了冠状动脉造影：结果显示单支血管病变、双支血管病变和三支血管病变分别占40%、29%和22%；9%的患者无严重冠状动脉病变。左心室射血分数为0.58±0.13。分别有36%、24%和40%的病例选择了药物治疗、冠状动脉搭桥手术和经皮心肌血运重建。在我们中心，80例患者中有58例（73%）在入院后6.8±5.6天接受了冠状动脉成形术，其中42例（74%）使用了支架。总住院时间为10.4±4天。在初次入院期间和随后一年，累积不良事件（死亡和非致命性心肌梗死）分别发生在2.5%和7%的患者中。
在没有心脏外科设施的情况下，对于不稳定型心绞痛患者，在有介入心脏病学的医院中采用早期积极治疗方法是可行的。在中度风险队列中，该策略近期良好的临床结果在一年随访中似乎持续存在。
