We conducted a multicenter, randomized, prospective study comparing medical therapy alone with coronary-artery bypass surgery plus medical therapy in 468 men with unstable angina pectoris. Patients were entered in the study from June 1, 1976, to June 30, 1982. Among those assigned to surgery who received bypass grafts, operative mortality was 4.1 percent. Arteriography performed after one year of follow-up revealed that 74.8 percent of the grafts studied were patent. The cumulative rate of crossover from medical to surgical therapy after two years was 34 percent; the operative mortality among patients crossed over was 10.3 percent. Nonfatal myocardial infarction occurred in 11.7 percent of the patients treated surgically and 12.2 percent of those treated medically (no significant difference). Most of the nonfatal myocardial infarctions in the surgical group occurred in the perioperative period. Overall, the two-year survival rate computed by life-table analysis did not differ between the two groups. However, the curves reflecting mortality as a function of left ventricular ejection fraction were significantly different (P = 0.03); surgery was associated with a significantly reduced mortality among patients with lower ejection fractions. We conclude that patients with unstable angina pectoris have a similar outcome after two years whether they receive medical therapy alone or coronary bypass surgery plus medical therapy. However, patients with reduced left ventricular ejection fractions may have a better two-year survival rate after coronary bypass surgery.
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[Full Text]
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[Abstract][Full Text]
Baker, C. S R
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[Full Text]
Al-Ruzzeh, S., Athanasiou, T., George, S., Glenville, B. E., DeSouza, A. C., Pepper, J. R., Amrani, M.
(2003). Is the use of cardiopulmonary bypass for multivessel coronary artery bypass surgery an independent predictor of operative mortality in patients with ischemic left ventricular dysfunction?. Ann. Thorac. Surg.
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[Abstract][Full Text]
Sundt, T. M. III, Gersh, B. J., Smith, H. C.
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[Full Text]
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[Abstract][Full Text]
Bertrand, M. E., Simoons, M. L., Fox, K. A.A., Wallentin, L. C., Hamm, C. W., McFadden, E., De Feyter, P. J., Specchia, G., Ruzyllo, W.
(2002). Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J
23: 1809-1840
[Full Text]
Janzon, M., Levin, L.A., the Fast revaxcularisation during InStability in C,
(2002). Cost-effectiveness of an invasive strategy in unstable coronary artery disease. Results from the FRISC II invasive trial. Eur Heart J
23: 31-40
[Abstract]
Arom, K. V., Emery, R. W., Flavin, T. F., Kshettry, V. R., Petersen, R. J.
(2001). OPCAB surgery: a critical review of two different categories of pre-operative ejection fraction. Eur. J. Cardiothorac. Surg.
20: 533-537
[Abstract][Full Text]
Morrison, D. A., Sethi, G., Sacks, J., Henderson, W., Grover, F., Sedlis, S., Esposito, R., Ramanathan, K., Weiman, D., Saucedo, J., Antakli, T., Paramesh, V., Pett, S., Vernon, S., Birjiniuk, V., Welt, F., Krucoff, M., Wolfe, W., Lucke, J. C., Mediratta, S., Booth, D., Barbiere, C., Lewis, D., for the Investigators of the Department of Veteran,
(2001). Percutaneous coronary intervention versus coronary artery bypass graft surgery for patients with medically refractory myocardial ischemia and risk factors for adverse outcomes with bypass: a multicenter, randomized trial. J Am Coll Cardiol
38: 143-149
[Abstract][Full Text]
Al-Shanafey, S., Dodds, L., Langille, D., Ali, I., Henteleff, H., Dobson, R.
(2001). Nodal vessels disease as a risk factor for atrial fibrillation after coronary artery bypass graft surgery. Eur. J. Cardiothorac. Surg.
19: 821-826
[Abstract][Full Text]
British Cardiac Society Guidelines and Medical Pra, , Royal College of Physicians Clinical Effectiveness,
(2001). Guideline for the management of patients with acute coronary syndromes without persistent ECG ST segment elevation. Heart
85: 133-142
[Full Text]
Braunwald, E., Antman, E. M., Beasley, J. W., Califf, R. M., Cheitlin, M. D., Hochman, J. S., Jones, R. H., Kereiakes, D., Kupersmith, J., Levin, T. N., Pepine, C. J., Schaeffer, J. W., Smith, E. E. III, Steward, D. E., Theroux, P., Gibbons, R. J., Alpert, J. S., Eagle, K. A., Faxon, D. P., Fuster, V., Gardner, T. J., Gregoratos, G., Russell, R. O., Smith, S. C. Jr
(2000). ACC/AHA guidelines for the management of patients with unstable angina and non-st-segment elevation myocardial infarction: A report of the american college of cardiology/ american heart association task force on practice guidelines (committee on the management of patients with unstable angina). J Am Coll Cardiol
36: 970-1062
[Full Text]
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(2000). Management of acute coronary syndromes: acute coronary syndromes without persistent ST segment elevation. Recommendations of the Task Force of the European Society of Cardiology: Recommendations of the Task Force of the European Society of Cardiology. Eur Heart J
21: 1406-1432
Arom, K. V., Flavin, T. F., Emery, R. W., Kshettry, V. R., Petersen, R. J., Janey, P. A.
(2000). Is low ejection fraction safe for off-pump coronary bypass operation?. Ann. Thorac. Surg.
70: 1021-1025
[Abstract][Full Text]
Lesperance, F., Frasure-Smith, N., Juneau, M., Theroux, P.
(2000). Depression and 1-Year Prognosis in Unstable Angina. Arch Intern Med
160: 1354-1360
[Abstract][Full Text]
Abrahamsson, P, Rosengren, A, Dellborg, M
(2000). Improved long-term prognosis for patients with unstable coronary syndromes 1988-1995. Eur Heart J
21: 533-539
[Abstract]
Yeghiazarians, Y., Braunstein, J. B., Askari, A., Stone, P. H.
(2000). Unstable Angina Pectoris. NEJM
342: 101-114
[Full Text]
Eagle, K. A., Guyton, R. A., Davidoff, R., Ewy, G. A., Fonger, J., Gardner, T. J., Gott, J. P., Herrmann, H. C., Marlow, R. A., Nugent, W. C., O'Connor, G. T., Orszulak, T. A., Rieselbach, R. E., Winters, W. L., Yusuf, S., Gibbons, R. J., Alpert, J. S., Eagle, K. A., Gardner, T. J., Garson, A. Jr., Gregoratos, G., Russell, R. O., Smith, S. C. Jr.
(1999). ACC/AHA guidelines for coronary artery bypass graft surgery: A report of the American College of Cardiology/ American Heart Association task force on Practice Guidelines (Committee to revise the 1991 Guidelines for Coronary Artery Bypass Graft Surgery). J Am Coll Cardiol
34: 1262-1347
[Full Text]
Abrahamsson, P., Andersen, K., Eriksson, P., Dellborg, M.
(1999). Prognostic value of maximum ST-vector magnitude during the first 24h of vectorcardiographic monitoring in patients with unstable angina pectoris. Eur Heart J
20: 1166-1174
[Abstract]
Kontos, M. C., Jesse, R. L., Anderson, F. P., Schmidt, K. L., Ornato, J. P., Tatum, J. L.
(1999). Comparison of Myocardial Perfusion Imaging and Cardiac Troponin I in Patients Admitted to the Emergency Department With Chest Pain. Circulation
99: 2073-2078
[Abstract][Full Text]
Halon, D. A., Flugelman, M. Y., Merdler, A., Rennert, H., Shahla, J., Lewis, B. S.
(1998). Long-term (10-year) outcome in patients with unstable angina pectoris treated by coronary balloon angioplasty. J Am Coll Cardiol
32: 1603-1609
[Abstract][Full Text]
Every, N. R., Cannon, C. P., Granger, C., Moliterno, D. J., Aguirre, F. V., Talley, J. D., Booth, J., Sapp, S., Ferguson, J. J., for the GUARANTEE investigators,
(1998). Influence of insurance type on the use of procedures, medications and hospital outcome in patients with unstable angina: results from the GUARANTEE registry. J Am Coll Cardiol
32: 387-392
[Abstract][Full Text]
Giugliano, R. P., Camargo, C. A. Jr, Lloyd-Jones, D. M., Zagrodsky, J. D., Alexis, J. D., Eagle, K. A., Fuster, V., O'Donnell, C. J.
(1998). Elderly Patients Receive Less Aggressive Medical and Invasive Management of Unstable Angina: Potential Impact of Practice Guidelines. Arch Intern Med
158: 1113-1120
[Abstract][Full Text]
Theroux, P., Fuster, V.
(1998). Acute Coronary Syndromes : Unstable Angina and Non–Q-Wave Myocardial Infarction. Circulation
97: 1195-1206
[Full Text]
Van Miltenburg-Van Zijl, A. J.M., Bossuyt, P. M.M., Nette, R. W., Simoons, M. L., Taylor, T. R.
(1997). Cardiologists' Use of Clinical Information for Management Decisions for Patients with Unstable Angina:: A Policy Analysis. Med Decis Making
17: 292-297
[Abstract]
Lindahl, B., Venge, P., Wallentin, L.
(1996). Relation Between Troponin T and the Risk of Subsequent Cardiac Events in Unstable Coronary Artery Disease. Circulation
93: 1651-1657
[Abstract][Full Text]
Mickleborough, L. L., Maruyama, H., Takagi, Y., Mohamed, S., Sun, Z., Ebisuzaki, L.
(1995). Results of Revascularization in Patients With Severe Left Ventricular Dysfunction. Circulation
92: 73-79
[Abstract][Full Text]
Louagie, Y. A. G., Jamart, J., Buche, M., Eucher, P. M., Schoevaerdts, D., Collard, E., Gonzalez, M., Marchandise, B., Schoevaerdts, J.-C.
(1995). Operation for Unstable Angina Pectoris: Factors Influencing Adverse In-Hospital Outcome. Ann. Thorac. Surg.
59: 1141-1149
[Abstract][Full Text]
Theroux, P.
(1995). Angiographic and Clinical Progression in Unstable Angina : From Clinical Observations to Clinical Trials. Circulation
91: 2295-2298
[Full Text]
Johnson, E., Ports, T.
(1988). Unstable Angina Pectoris: An Interventional Approach to Management. J Intensive Care Med
3: 202-214
[Abstract]
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