The Journal of Thoracic and Cardiovascular Surgery, Vol 69, 73-81, Copyright © 1975 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
The rationale for surgery in preinfarction angina
JM Matloff, H Sustaita, K Chatterjee, A Chaux, HS Marcus and HJ Swan
Of 123 patients with identical clinical criteria for preinfarction angina,
35 were treated medically and 88 surgically in a nonrandomized manner.
There was no statistical difference between these two therapeutic groups in
regard to age range, average age, sex distribution, number and distribution
of prior myocardial infarction, and duration of chronic and acute anginal
symptoms. With medical therapy, 32 sustained a myocardial infarction, and
14 (40 per cent) of these died within 1 month of hospital admission.
Thirteen of 21 survivors or 37 per cent of the original group are
asmptomatic on continuing medical therapy an average of 15 months after
discharge. The surgical patients were studied by catherization and
anigiography and underwent an early operation. Eight (9.4 per cent)
demonstrated evidence of postoperative infarction, and 3 (3.4 per cent)
died after the operation. Seventy-one (84 per cent) are completely
asymptomatic and 6 are less symptomatic an average of 17 months after the
operation. Actuarial analysis of the follow-up data reveals that the
initial significant difference in survival between the two groups is
maintained through the first 36 months. On the basis of this experience, we
suggest that surgical intervention is the therapy of choice in patients
with preinfarction angina.
