[Isolated stenosis of the anterior interventricular artery. Comparison of the effects of medical and surgical treatment (in a randomised series)].
Forty-five patients presenting with unstable angina having 70 p. 100 stenosis of the left anterior descending artery judged acceptable for coronary bypass surgery were randomly allocated, using a table of random numbers, for medical (21 patients) or surgical treatment (24 patients). There were no significant differences between the two groups with regards to age (53 +/- 10 years for the medical group; 55 +/- 9 years for the surgical group), the length of follow-up (55 +/- 26 vs 61 +/- 28 months), left ventricular end diastolic volumes (87 +/- 27 vs 84 +/- 18 ml/m2) or ejection fraction (62 +/- 8 vs 59 +/- 11 p. 100). There were no deaths in the medical group; two patients developed uncomplicated myocardial infarction 19 days and 7 months after coronary angiography, respectively. 5 patients had recurrent angina and were referred for surgery. This operation of second intention did not pose any special problems. 6 of the 14 patients with stenosis of the LAD before the origin of the first septal artery had complications (infarction in 1 case, recurrent angina in 5 cases). In the surgical group, 1 patient died in the immediate postoperative period, of resistant cardiac arrhythmia; 2 patients developed uncomplicated peroperative myocardial infarction; 21 patients had no complications at all. The surgical patients were heparinised in the immediate postoperative period and anticoagulant therapy was continued with oral vitamin K antagonists for 6 months to 1 year, followed in some cases, by platelet antiaggregant therapy. 20 patients in this group underwent maximal exercise stress testing which was negative in 19 cases.(ABSTRACT TRUNCATED AT 250 WORDS)
Bardet
J
J
Baudet
M
M
Dubourg
O
O
Ferrier
A
A
Guéret
P
P
Rigaud
M
M
Gandjbakhch
I
I
Bourdarias
J P
JP
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000789:Angina, Unstable / Q000628:therapy; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009574:Nitro Compounds / Q000627:therapeutic use; D011379:Prognosis
D000319:Adrenergic beta-Antagonists; D002121:Calcium Channel Blockers; D009574:Nitro Compounds; D006493:Heparin
Sténose isolée de l'artère interventriculaire antérieure. Comparaison des effets du traitement médical et du traitement chirurgical (dans une série randomisée).