The rationale for surgery in preinfarction angina.
Of 123 patients with identical clinical criteria for preinfarction angina, 35 were treated medically and 88 surgically in a nonrandomized manner. There was no statistical difference between these two therapeutic groups in regard to age range, average age, sex distribution, number and distribution of prior myocardial infarction, and duration of chronic and acute anginal symptoms. With medical therapy, 32 sustained a myocardial infarction, and 14 (40 per cent) of these died within 1 month of hospital admission. Thirteen of 21 survivors or 37 per cent of the original group are asmptomatic on continuing medical therapy an average of 15 months after discharge. The surgical patients were studied by catherization and anigiography and underwent an early operation. Eight (9.4 per cent) demonstrated evidence of postoperative infarction, and 3 (3.4 per cent) died after the operation. Seventy-one (84 per cent) are completely asymptomatic and 6 are less symptomatic an average of 17 months after the operation. Actuarial analysis of the follow-up data reveals that the initial significant difference in survival between the two groups is maintained through the first 36 months. On the basis of this experience, we suggest that surgical intervention is the therapy of choice in patients with preinfarction angina.
D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000150:complications / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D000792:Angiography; D006328:Cardiac Catheterization; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D005260:Female; D005500:Follow-Up Studies; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy; D011183:Postoperative Complications; D011433:Propranolol / Q000627:therapeutic use
D006493:Heparin; D011433:Propranolol