Wilkinson L, Ellis C J, Gorden G D, Sharpe D N
Department of Medicine, Auckland Hospital.
N Z Med J. 1998 Aug 14;111(1071):288-91.
To review the clinical management of patients with unstable angina and to relate prospectively initial risk stratification, according to the Braunwald criteria, to subsequent cardiovascular events.
From February to April 1996 we performed a three month prospective review of all patients with a diagnosis of unstable angina admitted to the coronary care unit at Auckland Hospital.
One hundred and four patients (61% male), with a mean age of 64 years, were classified as high (58%), intermediate (41%) or low risk (1%) for an adverse cardiac event. Twelve (12%) patients had a documented myocardial infarction, of whom 11 were in the high-risk group (p = 0.038). During hospitalisation there was one death. Twelve (12%) patients underwent inpatient exercise testing, five of whom proceeded to a coronary angiogram prior to hospital discharge. Twenty-two (21%) unstable patients underwent inpatient angiography without prior exercise testing. Twenty-one (20%) patients required revascularisation on the same admission: percutaneous coronary angioplasty (n = 14) or coronary artery bypass grafting (n = 7). Twelve of these 21 patients were in the high-risk group (p = 0.999, NS).
Patients admitted with unstable angina had low inpatient mortality but a 12% rate of subsequent myocardial infarction. Braunwald low-risk unstable angina patients were not admitted to the coronary care unit. Braunwald high-risk patients were more likely to develop a subsequent myocardial infarction. Stratification of patients into intermediate or high-risk groups did not relate to initial medical management or subsequent revascularisation. Thus, while this method of risk stratification may predict cardiovascular events, it may be of limited clinical use in the New Zealand environment.
回顾不稳定型心绞痛患者的临床管理，并根据布劳恩瓦尔德标准前瞻性地将初始风险分层与随后的心血管事件相关联。
1996年2月至4月，我们对奥克兰医院冠心病监护病房收治的所有诊断为不稳定型心绞痛的患者进行了为期三个月的前瞻性研究。
104例患者（男性占61%），平均年龄64岁，被分为不良心脏事件高风险（58%）、中风险（41%）或低风险（1%）组。12例（12%）患者有心肌梗死记录，其中11例在高风险组（p = 0.038）。住院期间有1例死亡。12例（12%）患者接受了住院运动试验，其中5例在出院前行冠状动脉造影。22例（21%）不稳定患者未进行运动试验即接受了住院血管造影。21例（20%）患者在同一住院期间需要进行血运重建：经皮冠状动脉成形术（n = 14）或冠状动脉旁路移植术（n = 7）。这21例患者中有12例在高风险组（p = 0.999，无统计学意义）。
因不稳定型心绞痛入院的患者住院死亡率低，但随后心肌梗死发生率为12%。布劳恩瓦尔德低风险不稳定型心绞痛患者未收入冠心病监护病房。布劳恩瓦尔德高风险患者更易发生随后的心肌梗死。将患者分为中风险或高风险组与初始药物治疗或随后的血运重建无关。因此，虽然这种风险分层方法可能预测心血管事件，但在新西兰环境下其临床应用可能有限。
