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[Surgical therapy in unstable angina pectoris]
L K von Segesser1, J Poop, A Laske
1Klinik für Herz- und Gefässchirurgie, Universitätsspital, Zürich.
Praxis
|February 21, 1995
Summary
Surgical revascularization offers comparable outcomes for patients with unstable angina pectoris and stable angina pectoris. This study found no significant differences in mortality or adverse events between the two groups following coronary artery bypass grafting.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Clinical Outcomes Research
Context:
- Investigated the value of surgical revascularization in New York Heart Association (NYHA) class IV patients.
- Included 551 consecutive patients, with 362 diagnosed with unstable angina pectoris (UAP) and 189 with stable angina pectoris (SAP) as controls.
- Excluded patients with acute myocardial infarction.
Purpose:
- To assess the efficacy and outcomes of surgical revascularization for coronary artery disease in patients with NYHA class IV unstable angina pectoris.
- Compared surgical results between UAP and SAP patients.
Summary:
- Mean follow-up was 72 months. No significant differences in age, three-vessel disease, ejection fraction, or cardiogenic shock.
- Patients with UAP received more aortocoronary grafts (3.8 vs. 3.4, p < 0.05) and required intra-aortic balloon pumps more often (8% vs. 3%).
- Thirty-day surgical mortality was similar: 2% for UAP versus 3% for SAP (not significant).
Impact:
- Surgical revascularization demonstrates comparable short-term safety and efficacy for both unstable and stable angina pectoris in NYHA class IV patients.
- Highlights the need for careful patient selection and management in complex coronary artery disease.
- Provides evidence for the role of surgical intervention in severe angina, irrespective of stability, in this patient population.