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[Severity of stabilized angina pectoris and indication for coronary bypass-implications for prognosis]
Insights
Patients with mild angina pectoris and significant coronary artery disease have a favorable prognosis. This study suggests delaying aggressive treatment until symptoms worsen, even with severe blockages.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Clinical Medicine
Background:
- The prognosis for patients with mild to moderate angina pectoris (Class I-II) and significant coronary artery lesions (≥70% diameter reduction) remains debated.
- Historically, such cases have been managed non-operatively in this division since 1967.
Purpose of the Study:
- To evaluate the outcomes of non-operative management in mildly symptomatic patients with significant coronary artery disease.
- To compare the prognosis of mildly symptomatic, non-operated patients with markedly symptomatic patients who did not undergo bypass surgery.
Main Methods:
- Retrospective comparison of 61 mildly symptomatic, non-operated patients (Group I) with 65 markedly symptomatic patients not undergoing bypass (Group II).
- Analysis of 8-year mortality rates based on symptom severity and coronary artery disease extent.
Main Results:
- The 8-year mortality rate was 17% in Group I versus 40% in Group II.
- For single-vessel disease patients, 8-year mortality was 9.4% in Group I compared to 34% in Group II.
- Mild angina pectoris (Class I-II) demonstrated a favorable prognosis, with only one death in the first four years in Group I.
Conclusions:
- Mild and moderate angina pectoris, even with significant coronary artery lesions, is associated with a favorable long-term prognosis.
- An aggressive surgical approach can be deferred in favor of medical management until symptoms progress.
- Non-operative management may be a justifiable strategy for selected patients with mild angina and significant coronary artery disease.
Abstract:
The prognosis in patients with mild or moderate angina pectoris (class I or I-II) and significant coronary artery lesions (70% or more luminal diameter reduction) is controversial. Since 1967 these cases have not been operated upon in our Division. To assess the justice of this approach, 61 mildly symptomatic, non-operated patients (group I) were compared with 65 markedly symptomatic (class II to IV) patients in whom coronary artery bypass procedures were indicated but not performed (group II). These patients either had refused surgery or the lesions were considered unsuited to revascularization. Although 44 patients in group I had 70% or more stenosis of one or more coronary arteries, the 8-year mortality rate in group I was 17% compared with 40% in group II. For patients with single vessel disease (32 patients in group I, 35 patients in group II) the 8-year mortality was 9.4% in group I and 34% in group II; the difference is significant. This retrospective study suggests that mild and moderate angina pectoris (class I or I-II with or without medical treatment) is associated with a rather favourable prognosis (one single death during the first four years in group I). It may be concluded that an aggressive approach can be delayed until further symptoms develop despite adequate medical therapy.