Identification of unstable angina patients who have favorable outcome with medical or surgical therapy (eight-year follow-up of the Veterans Administration Cooperative Study).
To identify patients with unstable angina (UA) who have favorable outcomes with medical therapy or surgery, 468 patients who had been randomized in the Veterans Administration Cooperative Study of UA were risk-stratified based on angiographic criteria of the number of coronary arteries diseased and left ventricular ejection fraction (LVEF). Patients at high risk for UA were defined as those with 3-vessel disease or LVEF of < or = 58%, and patients at low risk were those with 1- or 2-vessel disease and LVEF of > 58%. Of the 468 UA patients randomized, 287 patients belonged to the high-risk and 181 to the low-risk category. In the low-risk group, cumulative mortality after 8 years of follow-up was significantly lower in the medically treated patients (16.8%) than in the surgically treated patients (32.2%) (p = 0.022); in the high-risk group, cumulative mortality was significantly lower in the surgically treated patients (24.1%) than in the medically treated patients (35.3%) (p = 0.03). The relative risk of surgery (the ratio of surgical to medical risk) in the low-risk patients was 1.67, indicating a significant survival advantage with medical treatment (p = 0.05), whereas the relative risk of surgery for the high-risk group was 0.71, indicating a significant survival benefit with surgical treatment (p < 0.05). Thus, medical therapy appears to be the preferred therapy for UA patients with only 1- or 2-vessel disease and normal LVEF, and surgery is preferred for UA patients with 3-vessel disease or LVEF in the lowest tercile.
Sharma
G V
GV
Department of Cardiology, Department of Veterans Affairs Medical Center, West Roxbury, Massachusetts 02132.
Deupree
R H
RH
Luchi
R J
RJ
Scott
S M
SM
D000789:Angina, Unstable / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000503:physiopathology* / Q000601:surgery; D003331:Coronary Vessels / Q000473:pathology; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs; D016277:Ventricular Function, Left / Q000502:physiology