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Coronary Bypass Surgery for Unstable Angina Pectoris: Title and subTitle BreakLong-Term Survival and Function FREE

John S. Schroeder, MD; Irene Lamb, RN; Marie Hu, MA; Edward B. Stinson, MD
[+] Author Affiliations

Reprint requests to Cardiology Division, Stanford University School of Medicine, Stanford, CA 94305 (Dr Schroeder).


JAMA. 1977;237(24):2609-2612. doi:10.1001/jama.1977.03270510031016
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The first 81 patients to undergo coronary artery bypass surgery for unstable angina pectoris at Stanford Hospital have been observed for a mean of 40.8 months. Surgical mortality was 8.5%, and perioperative incidence of myocardial infarction was 16%. The mean 18-month follow-up showed two early cardiac deaths and 12 additional myocardial infarctions. Sixty-seven percent of the patients were angina-free, and the condition of none was worse.

After a mean of 40.8 months, two late cardiac deaths and two myocardial infarctions had occurred. Complete relief of angina was present in 51%; 22% had unstable or worsening angina. The probability of survival from time of operation to four months after surgery was 88.8%±3.5%, and this remained unchanged until the two late deaths, which decreased survival probability to 83.8%±4.8% at 43 months. The two late cardiac deaths and the 22% incidence of patients with worsening angina may reflect progression of the atherosclerotic process, late graft occlusion, or both.

(JAMA 237:2609-2612, 1977)

REFERENCES

Conti CR, Gilbert JB, Hodges M, et al:  Unstable angina pectoris: Randomized study of surgical versus medical therapy , abstracted. Am J Cardiol 35:129, 1975;.
Selden R, Neill WA, Ritzmann LW, et al:  Medical versus surgical therapy for acute coronary insufficiency: A randomized study . N Engl J Med 293:1329-1333, 1975;.
Miller DC, Cannom DS, Fogarty TJ, et al:  Saphenous vein coronary artery bypass in patients with "pre-infarction angina ." Circulation 47:234-241, 1973;.
Kaplan EL, Meier P:  Nonparametric estimation from incomplete observations . Am Statistical Assoc J 53:457-481, 1958;.
Gehan EA:  A generalized Wilcoxon test for comparing arbitrarily single-censored samples . Biometrica 52:203-223, 1965;.
Berndt TB, Miller DC, Silverman JF, et al:  Coronary bypass surgery for unstable angina pectoris: Clinical follow-up and results of postoperative treadmill electrocardiograms . Am J Med 58:171-176, 1975;.
Bonchek LI, Rahimtoola SH, Anderson RP, et al:  Late results following emergency saphenous vein bypass grafting for unstable angina . Circulation 50:972-977, 1974;.
Auer JR, Johnson D, Flemma RJ, et al:  Direct coronary artery surgery for impending myocardial infarction , abstracted. Circulation , (suppl 2) , 1971;, pp 11-102.
Lambert CJ, Adam M, Geisler GF, et al:  Emergency myocardial revascularization for impending infarctions and arrhythmias . J Thorac Cardiovasc Surg 62:522-528, 1971;.
Favaloro RG, Effler DB, Cheanvechai C, et al:  Acute coronary insufficiency (impending myocardial infarction and myocardial infarction): Surgical treatment by the saphenous vein graft technique . Am J Cardiol 28:598-607, 1971;.
Tecklenberg PL, Alderman EL, Miller DC, et al:  Changes in survival and symptom relief in a longitudinal study of patients after bypass surgery . Circulation , (suppl 1) , 1975;, pp 98-104.
Alderman EL, Matlof HJ, Shumway NE, et al:  Evaluation of enzyme testing for the detection of myocardial infarctionfollowing direct coronary artery surgery . Circulation 48:135-140, 1973;.
Lapin ES, Murray JA, Bruce RA, et al:  Changes in maximal exercise performance in the evaluation of saphenous vein bypass surgery . Circulation 47:1164-1173, 1973;.
Bartel AG, Behar VS, Peter RH, et al:  Exercise stress testing in evaluation of aortocoronary bypass surgery: Report of 123 patients , abstracted. Clin Res 20:24, 1972;.

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Conti CR, Gilbert JB, Hodges M, et al:  Unstable angina pectoris: Randomized study of surgical versus medical therapy , abstracted. Am J Cardiol 35:129, 1975;.
Selden R, Neill WA, Ritzmann LW, et al:  Medical versus surgical therapy for acute coronary insufficiency: A randomized study . N Engl J Med 293:1329-1333, 1975;.
Miller DC, Cannom DS, Fogarty TJ, et al:  Saphenous vein coronary artery bypass in patients with "pre-infarction angina ." Circulation 47:234-241, 1973;.
Kaplan EL, Meier P:  Nonparametric estimation from incomplete observations . Am Statistical Assoc J 53:457-481, 1958;.
Gehan EA:  A generalized Wilcoxon test for comparing arbitrarily single-censored samples . Biometrica 52:203-223, 1965;.
Berndt TB, Miller DC, Silverman JF, et al:  Coronary bypass surgery for unstable angina pectoris: Clinical follow-up and results of postoperative treadmill electrocardiograms . Am J Med 58:171-176, 1975;.
Bonchek LI, Rahimtoola SH, Anderson RP, et al:  Late results following emergency saphenous vein bypass grafting for unstable angina . Circulation 50:972-977, 1974;.
Auer JR, Johnson D, Flemma RJ, et al:  Direct coronary artery surgery for impending myocardial infarction , abstracted. Circulation , (suppl 2) , 1971;, pp 11-102.
Lambert CJ, Adam M, Geisler GF, et al:  Emergency myocardial revascularization for impending infarctions and arrhythmias . J Thorac Cardiovasc Surg 62:522-528, 1971;.
Favaloro RG, Effler DB, Cheanvechai C, et al:  Acute coronary insufficiency (impending myocardial infarction and myocardial infarction): Surgical treatment by the saphenous vein graft technique . Am J Cardiol 28:598-607, 1971;.
Tecklenberg PL, Alderman EL, Miller DC, et al:  Changes in survival and symptom relief in a longitudinal study of patients after bypass surgery . Circulation , (suppl 1) , 1975;, pp 98-104.
Alderman EL, Matlof HJ, Shumway NE, et al:  Evaluation of enzyme testing for the detection of myocardial infarctionfollowing direct coronary artery surgery . Circulation 48:135-140, 1973;.
Lapin ES, Murray JA, Bruce RA, et al:  Changes in maximal exercise performance in the evaluation of saphenous vein bypass surgery . Circulation 47:1164-1173, 1973;.
Bartel AG, Behar VS, Peter RH, et al:  Exercise stress testing in evaluation of aortocoronary bypass surgery: Report of 123 patients , abstracted. Clin Res 20:24, 1972;.
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