title: [Treatment of stable angina pectoris: when to operate?].
abstract: The decision whether to treat the patient with stable angina medically or surgically is influenced by factors which determine the natural course of coronary artery disease: severity of coronary narrowing, presence or absence of collaterals, area of myocardium at risk, left ventricular function, presence of ventricular arrhythmias, risk factors. In the present study diagnostic criteria are discussed which may enable the physician to identify the coronary patient who is especially at risk for myocardial infarction or sudden death. Our knowledge of the natural course of ischemic heart disease and the medical and surgical possibilities has identified two groups of patients who profit from coronary bypass surgery: (1) patients with angina pectoris refractory to medical therapy, and (2) patients with left main disease or triple vessel disease, particularly if left ventricular function is also mildly to moderately affected. Patients with one- or two-vessel disease should undergo surgery only if proximal coronary narrowing jeopardizes a large myocardial area. The possibilities and limitations of percutaneous transluminal coronary angioplasty as an alternative to coronary bypass surgery are briefly discussed.
mesh_terms: D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000601:surgery*; D000800:Angioplasty, Balloon; D003097:Collateral Circulation; D001026:Coronary Artery Bypass; D004562:Electrocardiography; D006801:Humans; D011877:Radionuclide Imaging; D012306:Risk
vernacular_title: Behandlung der stabilen Angina pectoris: wann chirurgisch?