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Coronary bypass for stable angina: a prospective randomized study
Insights
Coronary-artery bypass surgery offers greater functional improvement and less unstable angina compared to medical therapy for stable angina patients. However, the study found no significant difference in the likelihood of death or myocardial infarction between the two treatments.
Area of Science:
- Cardiology
- Cardiac Surgery
- Internal Medicine
Background:
- Stable, disabling angina significantly impacts patient quality of life.
- Medical therapy is the standard treatment, but surgical intervention is an option.
Purpose of the Study:
- To compare the efficacy of coronary-artery bypass surgery versus medical therapy in patients with stable angina.
- To evaluate major cardiac events, functional status, and exercise performance.
Main Methods:
- 100 patients with stable angina were randomized to medical (49) or surgical (51) therapy.
- Follow-up included assessment of cardiac events, functional classification, and exercise testing.
Main Results:
- No statistical difference in major cardiac events (death, infarction) after three years.
- Surgical patients showed greater functional improvement and less unstable angina (P < 0.01).
- Surgical patients with three-vessel disease had fewer major events (P < 0.05).
Conclusions:
- Coronary-artery bypass surgery leads to better functional improvement and reduced unstable angina than medical therapy.
- The likelihood of death and myocardial infarction remains unchanged by surgical intervention in this patient group.
Abstract:
To evaluate the effects of coronary-artery bypass, 100 patients with stable, disabling angina were randomized to medical (49) or surgical (51) therapy. There was no statistical difference in major cardiac events after three years (death in five medical vs. four surgical, infarction in eight vs. 10, and unstable angina requiring operation or reoperation in eight vs. three cases). Surgical patients with three-vessel disease had fewer major events (P less than 0.05) than the comparable medical group and less unstable angina requiring operation (P less than 0.02). All unstable angina was less frequent in the surgical group (15 vs. six, P less than 0.01). Functional classification improved more in surgical patients at six months (P less than 0.01) and at late followup examination (P less than 0.05). After six months, surgical patients achieved significantly higher exercise work loads (P less than 0.01), exercise heart rates (P less than 0.05), maximum paced heart rates (P less than 0.01) and myocardial lactate extraction (P less than 0.01). On the basis of this interim report of a relatively small group of patients, we conclude that bypass results in greater functional improvement and less unstable angina than medical therapy. The likelihood of death and myocardial infarction is unchanged by operation.