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Clinical characteristics and current management of medically refractory unstable angina.

机译：难治性不稳定型心绞痛的临床特征和当前管理。

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Of 531 patients admitted to the Duke Coronary Care Unit with unstable angina (UA) from June 1981 to September 1982, 100 had persistent angina despite optimal medical therapy of nitrates, propranolol, and nifedipine. At catheterization, 70% of the refractory patients had left main (LM) or three-vessel disease (TVD), 68% had left ventricular end-diastolic pressures of greater than 12 mmHg, and 24% had ejection fractions (EF) of less than 0.40. Twenty-four patients were greater than 65 years of age, and 53 had associated major diseases. Forty-eight patients (Group I) had no evidence of myocardial infarction in the 30 days before catheterization, whereas 52 patients had an infarction precipitating the unstable angina within the preceding 30 days (Group II). Emergent coronary artery bypass grafting was performed in all 100 patients irrespective of ventricular function, hemodynamic status, or coronary anatomy. Management protocols included prompt surgical intervention, preoperative stabilization with the balloon pump in LM or TVD, meticulous myocardial protection, and complete coronary revascularization. An average of 3.6 grafts were placed in each patient. There were two hospital deaths in Group I, and two in Group II. Two-year survival was 90% in Group I and 88% in Group II, and 81% of surviving patients were NYHA Class I or II. Thus, refractory UA denotes particularly severe coronary disease with a high incidence of LM, TVD, and depressed EF. Baseline clinical characteristics, criteria for operation, and expected results in the postinfarction group seem to be similar to the unstable angina group in general. Cardiac anatomic and functional variables no longer constitute operative contraindications. Aggressive operative management is safe, and the current risk may be less dependent on coronary anatomy and ventricular function than previously appreciated.
机译：在1981年6月至1982年9月入院的531例不稳定型心绞痛（UA）患者中，尽管对硝酸盐，心得安和硝苯地平进行了最佳药物治疗，但仍有100例持续性心绞痛。进行导管插入术时，70％的难治性患者患有左主干（LM）或三支血管疾病（TVD），68％的左心室舒张末期压力大于12 mmHg，24％的射血分数（EF）较小大于0.40。 24名年龄大于65岁的患者，其中53名伴有重大疾病。在导管插入前30天中，有48名患者（I组）没有心肌梗塞的证据，而在过去30天内，有52名患者因不稳定型心绞痛而导致了心肌梗塞（II组）。不论心室功能，血流动力学状况或冠状动脉解剖结构如何，所有100例患者均进行了紧急冠状动脉搭桥术。处理方案包括及时的外科手术干预，LM或TVD气囊泵的术前稳定，精心的心肌保护以及完全的冠脉血运重建。每个患者平均放置3.6个移植物。第一类有两例医院死亡，第二类有两例。 I组的两年生存率为90％，II组的为88％，81％的幸存患者为NYHA I类或II类。因此，难治性UA表示特别严重的冠状动脉疾病，其LM，TVD和EF降低的发生率很高。梗死后组的基线临床特征，手术标准和预期结果似乎总体上与不稳定型心绞痛相似。心脏的解剖和功能变量不再构成手术禁忌症。积极的手术管理是安全的，并且当前的风险可能比以前认识到的更少依赖于冠状动脉解剖结构和心室功能。

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