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Acute coronary insufficiency. Review of 46 patients
Insights
Acute coronary insufficiency requires initial medical therapy. However, many patients later need surgery for disabling angina, with early interventions carrying high risks but offering improved long-term outcomes for survivors.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Acute coronary insufficiency presents a significant clinical challenge.
- Understanding the long-term management and outcomes is crucial.
Purpose of the Study:
- To review the clinical and angiographic findings, management strategies, and outcomes for patients with acute coronary insufficiency.
- To evaluate the efficacy and risks associated with different treatment pathways, including medical therapy and surgical intervention.
Main Methods:
- Retrospective review of 46 patients admitted with acute coronary insufficiency.
- Coronary angiography performed in all patients.
- Analysis of clinical data, management decisions, and patient follow-up.
Main Results:
- Of 42 patients with coronary artery disease, 33% underwent emergency angiography for persistent rest pain, with a 21% mortality and high perioperative complications (myocardial infarction) after bypass grafting.
- 41% of patients who initially improved required surgery within 6 months due to recurrent symptoms.
- 26% of patients were managed without surgery.
- Survivors of surgery reported symptomatic improvement with low late mortality and infarction rates.
Conclusions:
- Initial management of acute coronary insufficiency should focus on intensive medical therapy.
- A substantial proportion of patients will eventually require surgical intervention for disabling angina.
- Early surgical investigation and intervention are associated with significant mortality and morbidity.
- Surgical revascularization offers symptomatic relief and improved long-term prognosis for survivors.
Abstract:
Forty-six patients admitted with acute coronary insufficiency are reviewed. All were investigated by coronary angiography; 4 had normal coronary arteries and are included in this study; the remainder had a distribution of coronary artery disease similar to other angina patients. The clinical and angiographic findings, management, and subsequent course of the other 42 patients are presented. Fourteen patients (33%) in whom rest pain persisted after 48 hours underwent emergency coronary angiography, with 3 deaths; of the surviving 11 who had acute saphenous vein bypass grafting, 2 died at operation and 3 had perioperative myocardial infarctions. Seventeen patients (41%) who initially improved required surgery within 6 months because of symptoms. Eleven patients (26%) were not operated on. It is concluded that acute coronary insufficiency is best managed initially by intensive medical therapy but a high proportion will require surgery later because of disabling angina. Early investigation and surgery are associated with a high mortality and incidence of myocardial infarction. Survivors of surgery are symptomatically improved and there is a low incidence of late infarction and death.