title: Does intensive medical therapy influence the outcome in unstable angina?
abstract: Three hundred and forty-six patients of all ages and both sexes were admitted to coronary care with documented unstable angina. Management was conservative, without the routine use of beta-blockers or calcium antagonists. Mortality was 3.2%, and the nonfatal myocardial infarction rate was 10.1% during the first 28 days. After one year, coronary mortality was 10.5% with a nonfatal infarction rate of 13.1%. Twenty-six patients were subjected to coronary artery bypass surgery, eleven during the first 28 days and fifteen subsequently. No patient underwent coronary angioplasty. The factors influencing immediate and long-term prognosis in these patients were studied. Persistence of pain in hospital, previous chronic angina, and age had an adverse effect on outcome. A total of 143 patients complained of persistent pain lasting for 24 hours or more. The use of beta blockers or calcium antagonists in patients with persistent pain exceeding five days did not appear to influence outcome. The current widespread adherence to "intensive medical treatment," including the routine use of beta blockers and calcium antagonists, is questioned.
authors.affiliation: Department of Cardiology, St. Vincent's Hospital, Dublin, Ireland.
authors.forename: R
authors.initials: R
authors.lastname: Mulcahy
authors.forename: R
authors.initials: R
authors.lastname: Conroy
authors.forename: R
authors.initials: R
authors.lastname: Katz
authors.forename: M
authors.initials: M
authors.lastname: Fitzpatrick
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000789:Angina, Unstable / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis
chemical_list: D000319:Adrenergic beta-Antagonists; D002121:Calcium Channel Blockers