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[Unstable angina pectoris: disease picture and study of its course]
Insights
This study on unstable angina found no significant survival difference between medical and surgical treatments over 4.2 years. However, medically treated patients experienced more severe angina symptoms post-treatment.
Area of Science:
- Cardiology
- Clinical Medicine
Context:
- Retrospective analysis of 123 unstable angina patients admitted between 1977-1983.
- Data collected on patient history, treatment, and outcomes including mortality and rehospitalization.
Purpose:
- To analyze the long-term history and outcomes of patients with unstable angina.
- Compare the effectiveness of medical versus early surgical intervention for unstable angina.
Summary:
- 123 patients (97 male, 26 female, avg. age 58.4) with unstable angina were followed for an average of 4.2 years.
- 80 patients received medical treatment, 43 underwent bypass surgery; surgical group had poorer ventricular function.
- Hospital mortality was higher in the surgical group (9.3%) vs. medical (2.5%), with similar infarction rates.
- Overall 3-year survival was 84% with no significant difference between groups; 50% rehospitalization rate.
- Medically treated patients reported more severe angina (NYHA class III/IV) post-study.
Impact:
- Highlights the importance of patient selection based on coronary pathomorphology and clinical status for surgical outcomes.
- Suggests that while survival may be similar, functional status differs between treatment groups.
- Provides historical data on unstable angina management and outcomes prior to widespread modern interventions.
Abstract:
The object of the present study is to analyse the history of patients with typical unstable angina. For this purpose the data of all patients admitted to the Hannover Medical School between 1977 and 1983 and taken to the CCU because of proven unstable angina (history, duration of symptoms, intrahospital mortality, incidence of infarction, medical or surgical therapy, coronary pathomorphology, mortality after release from hospital, late incidence of infarction and rehospitalization) were documented and stored on a data bank for statistical analysis. 123 patients were entered into the study (97 males, 26 females; average age 58.4 +/- 9.2 years); during hospitalization all patients had angina at rest, 94% had transient ECG-changes (ST-segment changes, BBB etc.). The average follow-up was 4.2 +/- 2.0 years. 80 patients of the whole study population were treated medically, 43 underwent early bypass surgery. The two groups were different with respect to coronary pathomorphology (number of diseased vessels) as well as left ventricular wall motion, which was significantly more impaired in the surgical group (p less than 0.05). The hospital-mortality in the surgical group amounted to 9.3% (n = 4), the incidence of infarction to 18.6% (n = 8); the hospital mortality in medically treated patients was 2.5% (n = 2), the incidence of infarction 7.5% (n = 6). During the whole study period (average follow-up 4.2 years) the overall mortality amounted to 21%, the infarction rate was 23.5%: The cumulative survival rates revealed no significant difference between the 2 groups: after 3 years 84% of all patients were still alive, 65% without new infarction during the observation period; the rate of rehospitalization amounted to 50%. At the end of the study class III or IV angina (NYHA-criteria) was much more common in the medically treated than in the surgically treated group (NYHA mean 2.5 versus 2.0; p less than 0.5). The relatively high rate of perioperative death and myocardial infarction in the surgical group is based on the selection of patients according to coronary pathomorphology and the clinical status.