The surgical treatment of unstable angina pectoris

Since the advent of saphenous vein bypass grafting as successful means of myocardial revascularization, a variety of coronary artery disease syndrome have come under surgical attack. The proper role of surgery in many of these coronary syndromes remains ill-defined. However, clear indications for surgical revascularization exist in patients with unstable angina pectoris, i.e., progressive angina and onset of rest pain and noctural angina in spite of adequate medical therapy. An analysis has been made of 100 consecutive patients with unstable angina pectoris who underwent myocardial revascularization over the past 2 years at the Woodruff Medical Center of Emory University. Included in this group are the following subgroups: 1) Emergency cases with pre-infarction angina (including Printzmetal angina); 2) Cases of combined valvular heart disease and coronary artery disease; and 3) Advanced coronary artery disease with certain complications of previous myocardial infarction. A discussion of the relative merits of saphenous vein grafts and internal mammary artery anastomoses is presented and indicates that the technique selected should be determined by the quality of the distal native coronary circulation. Surgical mortality and morbidity figures, patency rates of saphenous vein grafts and internal mammary artery anastomoses visualized postoperatively, and the number of patients wiht dramatic relief of angina pectoris in this series support current enthusiasms for available surgical techniques for myocardial revascularization.