Two-Year Follow-Up of Angina Pectoris: Medical or Surgical Therapy

Aronow, W. S.

doi:10.7326/0003-4819-82-2-208

Cited by 30 publications

(4 citation statements)

References 8 publications

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“…Consequently, most of the nongrafted arteries were essentially normal at the completion of surgery. Progression of the disease occurred proximal to 24.2% of the graft insertions and progressed to total occlusion in almost 50%; it occurred with equal frequency in association with patent as with occluded grafts. Progression of the disease distal to the graft insertion occurred in only two of 85 arteries examined but did not progress to total occlusion.…”

Section: Acceleration Of the Atherosclerotic Process In The Native CImentioning

confidence: 99%

“…through the summer of 1977.8 9 Yet fewer than 1,300 patients in this country have been studied and randomized into groups receiving or not receiving ACBG and followed for a period approaching three years. '9-22 24 fig. 3).…”

Section: Vol 57 No 3 March 1978mentioning

confidence: 99%

“…40 The symptomatic improvement is so marked that the patient frequently requires less medication after surgery than before. For example, Mathur and Guinn"9 found that for an average of 24 One of the pioneers of efforts to indirectly revascularize the heart was Claude Beck. In the early 1930s147 he proposed relieving ischemic pain by improving myocardial perfusion by encouraging vascular growth into the myocardium from the pericardium.…”

Section: Relief Of Pain Of Myocardial Ischemiamentioning

confidence: 99%

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The first decade of aortocoronary bypass grafting, 1967-1977. A review.

McIntosh¹,

Garcia²

1978

Circulation

194

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SUMMARY Despite a decade of experience with aortocoronary bypass grafting embracing 300,000 or more operations, indications for its use remain controversial. The controversy persists because of a lack of adequate controls with which to compare the clinical course of operated patients; only 1248 have been reported who have been studied in a carefully controlled and random manner.Benefit has been claimed frequently by comparing the course of patients treated surgically with medically treated patients followed the decade before. Such comparisons are not valid in view of the well documented changes in the natural history of coronary artery disease that have been occurring during the last decade.Despite a low operative mortality and rate of graft closure, available data in the literature do not indicate that initial symptomatic improvement necessarily persists, or that myocardial infarctions, arrhythmias, or congestive heart failure will be prevented, or that life will be prolonged in the vast majority of operated patients."It is much easier to write upon a disease than upon a remedy. The former is in the hands of nature and a faithful observer with an eye to tolerable judgment can not fail to delineate a likeness; the latter will ever be subject to the whim, the inaccuracy and the blunder of man."William Withering"

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Section: Acceleration Of the Atherosclerotic Process In The Native CImentioning

confidence: 99%

Section: Vol 57 No 3 March 1978mentioning

confidence: 99%

Section: Relief Of Pain Of Myocardial Ischemiamentioning

confidence: 99%

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The first decade of aortocoronary bypass grafting, 1967-1977. A review.

McIntosh¹,

Garcia²

1978

Circulation

194

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“…Prospective randomized studies [43][44][45][46], including the widely discussed Veterans Administration Cooperative Study, have all failed to demonstrate that surgically treated patients with clinically stable angina and adequate left ventricular function live longer than medically treated patients, unless left main coronary artery stenosis is present [47]. However, we and others [3] doubt the validity of these prospective studies and question the conclusions.…”

Section: Cardiac Catheterizationmentioning

confidence: 90%

Selection of patients for direct myocardial revascularization

Anderson

Ring

1978

World j. surg.

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The high incidence of ischemic heart disease and its associated mortality, morbidity, and socioeconomic implications have stimulated a great deal of interest and controversy regarding the relative roles of surgical and medical therapy. There is general agreement that stable angina pectoris can be substantially improved or relieved by coronary artery bypass grafting in at least 80% of patients, and that stable angina not responding to medical treatment is a firm indication for this procedure if adequate distal vessels for grafting are present. The effect of myocardial revascularization on longevity in stable angina patients is not certain except in the presence of significant obstruction of the left main coronary artery, where improved prognosis has been demonstrated. Evidence appears to be accumulating that surgical treatment improves prognosis in disease involving 3 vessels and 2 vessels, particularly if reversible left ventricular dysfunction is present. The prognosis in single-vessel coronary artery disease does not appear to be influenced by surgical therapy.Unstable angina pectoris appears to be best managed initially by intensive medical therapy and coronary angiography, with urgent surgery being done for significant left main coronary artery disease or uncontrolled angina, and elective surgery being done for multiple-vessel disease. Coronary artery bypass grafting for acute myocardial infarction remains of limited value unless complications such as cardiogenic shock occur, when the prognosis may be somewhat improved by an early aggressive surgical approach in selected cases.Improved selection of patients for direct myocardial revascularization in the future appears to depend on the de-

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Indications for Surgical Treatment of Stable Angina Pectoris

Aronow¹

1979

Arch Intern Med

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Two-Year Follow-Up of Angina Pectoris: Medical or Surgical Therapy

Cited by 30 publications

References 8 publications

The first decade of aortocoronary bypass grafting, 1967-1977. A review.

The first decade of aortocoronary bypass grafting, 1967-1977. A review.

Selection of patients for direct myocardial revascularization

Indications for Surgical Treatment of Stable Angina Pectoris

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