Medical versus surgical therapy for acute coronary insufficiency. A randomized study.
Forty patients with acute coronary insufficiency, including continued angina at rest and reversible ischemic electrocardiographic changes after hospitalization ("high-risk" subgroup), were randomly allotted to medical therapy or urgent surgical coronary bypass groups. In four months there were no deaths and two myocardial infarctions in 19 medical patients and one death and three myocardial infarctions in 21 surgical patients. Left ventricular ejection fraction did not change significantly in either group. The surgical patients had significantly higher functional capacities at four months as judged by lower symptomatic functional class (P less than 0.01), higher exercise angina threshold (P less than 0.001), higher pacing angina threshold (P less than 0.0001), and higher myocardial lactate extraction during pacing (P less than 0.0001). Initial medical management of patients with acute coronary insufficiency followed by elective coronary bypass in patients with continued disabling angina pectoris is a reasonable alternative to emergency bypass.
D000208:Acute Disease; D000328:Adult; D000787:Angina Pectoris / Q000188:drug therapy / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D001026:Coronary Artery Bypass / Q000009:adverse effects; D005080:Exercise Test; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D005996:Nitroglycerin / Q000627:therapeutic use; D010102:Oxygen Inhalation Therapy; D011433:Propranolol / Q000008:administration & dosage / Q000627:therapeutic use; D011446:Prospective Studies; D012008:Recurrence
D011433:Propranolol; D005996:Nitroglycerin