死亡率
非ST段抬高型急性冠状动脉综合征 (NSTE-ACS) 患者6个月总死亡率为4.8%。[79]Eagle KA, Lim MJ, Dabbous OH, et al. A validated prediction model for all forms of acute coronary syndrome: estimating the risk of 6-month postdischarge death in an international registry. JAMA. 2004;291:2727-2733.http://jama.jamanetwork.com/article.aspx?articleid=198895http://www.ncbi.nlm.nih.gov/pubmed/15187054?tool=bestpractice.com
6个月后NSTE-ACS患者人群死亡率超过ST段抬高型心肌梗死患者。[80]Savonitto S, Ardissino D, Granger CB, et al. Prognostic value of the admission electrocardiogram in acute coronary syndromes. JAMA. 1999;281:707-713.http://jama.jamanetwork.com/article.aspx?articleid=188842http://www.ncbi.nlm.nih.gov/pubmed/10052440?tool=bestpractice.com
NSTE-ACS患者在第12个月时心血管不良事件发生率（再发缺血、心肌梗死和死亡）高达10%，反映该类患者除了初始病变外，冠状动脉其他部位存在弥漫活动性动脉粥样硬化病变。[3]Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;64:e139-e228.http://content.onlinejacc.org/article.aspx?articleid=1910086http://www.ncbi.nlm.nih.gov/pubmed/25260718?tool=bestpractice.com[81]Chang WC, Boersma E, Granger CB, et al. Dynamic prognostication in non-ST-elevation acute coronary syndromes: insights from GUSTO-IIb and PURSUIT. Am Heart J. 2004;148:62-71.http://www.ncbi.nlm.nih.gov/pubmed/15215793?tool=bestpractice.com
预后因素
不稳定型心绞痛患者预后不良的标志包括静息疼痛、存在共病（例如糖尿病、高血压、血脂异常、肾功能衰竭）、左心衰竭征象、心电图 ST 段压低，心肌生物标志物升高和血管造影发现左主干疾病和多支血管病变。[82]Sheridan PJ, Crossman DC. Critical review of unstable angina and non-ST elevation myocardial infarction. Postgrad Med J. 2002;78:717-726.http://www.ncbi.nlm.nih.gov/pubmed/12509688?tool=bestpractice.com
不稳定型心绞痛患者死亡或非致死性心肌梗死的短期风险与下面一些因素有关：
风险评估模型
已经验证了整合各种预后标志物的风险评估模型，作为第 14 天、[83]Antman EM, Cohen M, Bernink PJ, et al. The TIMI risk score for unstable angina/non-ST elevation MI: a method for prognostication and therapeutic decision making. JAMA. 2000;284:835-842.http://jama.jamanetwork.com/article.aspx?articleid=192996http://www.ncbi.nlm.nih.gov/pubmed/10938172?tool=bestpractice.com第 30 天以及[84]Boersma E, Pieper KS, Steyerberg EW, et al; The PURSUIT Investigators. Predictors of outcome in patients with acute coronary syndromes without persistent ST-segment elevation. Results from an international trial of 9461 patients. Circulation. 2000;101:2557-2567.http://circ.ahajournals.org/content/101/22/2557.fullhttp://www.ncbi.nlm.nih.gov/pubmed/10840005?tool=bestpractice.com最多 6 个月时的结局预测因子。[85]Granger CB, Goldberg RJ, Dabbous O, et al. Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med. 2003;163:2345-2353.http://archinte.jamanetwork.com/article.aspx?articleid=216232http://www.ncbi.nlm.nih.gov/pubmed/14581255?tool=bestpractice.comGlobal Registry of Acute Coronary Events (GRACE) ACS risk model
这些NSTE-ACS短期结局预后模型对其1年死亡和心肌梗死事件仍具有预测价值。[86]Giugliano RP, Braunwald E. The year in non-ST-segment elevation acute coronary syndromes. J Am Coll Cardiol. 2005;46:906-919.http://www.ncbi.nlm.nih.gov/pubmed/16139143?tool=bestpractice.com
