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Ann Thorac Surg 1975;19:521-528
© 1975 The Society of Thoracic Surgeons

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Articles

Unstable Coronary Artery Disease: Comparison of Medical and Surgical Treatment

Division of Cardiac and Thoracic Surgery and the Division of Cardiology, Vanderbilt University School of Medicine, Nashville, Tenn

^* Address reprint requests to Dr. Bender, Division of Cardiac and Thoracic Surgery, Vanderbilt University School of Medicine, Nashville, Tenn. 37232

In eighty-eight patients with arteriographic findings of obstructive coronary artery disease and the clinical picture of unstable angina pectoris, a decision on operative or nonoperative management was made by the attending physician. Fifty-three of them subsequently underwent aortocoronary saphenous vein bypass grafting and 35 were continued on a program of medical therapy. A marked difference in the course after the first 30 days was noted, with most of the surgically managed patients being either asymptomatic or greatly improved following coronary artery bypass. Two-thirds of the medically treated patients had persistent severe angina pectoris and none was asymptomatic in a follow-up period averaging 20 months. There were 2 late deaths in the medical group and none in the surgical group.

These findings indicate that coronary artery bypass operations can be performed with low risk during the unstable phase of coronary artery disease and that relief of angina can be anticipated. In contrast, nonoperative management of unstable coronary artery disease carries an appreciable risk of death or myocardial infarction, and the majority of patients treated nonoperatively continue to experience angina.

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