Abstract
A randomized prospective study was carried out and the therapeutical effects of intensive medical management in the acute stage of unstable angina were compared with those of urgent coronary bypass surgery on patients admitted to Kanazawa Medical University Hospital, who showed an ST elevation or depression during their attacks. Seventy patients with unstable angina were evaluated clinically, angiographically and hemodynamically: 41 of them had a transient ST elevation (26 treated medically; 15 surgically) and 29 had a transient ST depression (15 treated medically; 14 surgically). The hospital mortality rates were 12.2% for the medical group (3.8% in patients with an ST elevation; 26.7% in an ST depression) and 17.2% for the surgical group (6.7% in an ST elevation; 28.6% in an ST depression). These differences were not significant. The incidence of myocardial infarction among in-patients was 7.3% in the medical group (0% in the patients with an ST elevation; 20% in an ST depression) and 13.8% in the surgical group (13.3% in an ST elevation; 14.3% in an ST depression). These differences were also not significant. On their coronary angiograms, single vessel disease was significantly frequent in unstable angina with an ST elevation and so was triple vessel disease in patients with an ST depression. Left ventricular function was markedly improved in patients with an ST elevation after coronary bypass surgery. However, in unstable angina with an ST depression, there was no amelioration of left ventricular contractility and relaxation. It is concluded that by medical or surgical treatment, patients with unstable angina showing an ST elevation during their attacks had a fairly better prognosis than those showing an ST depression; the left ventricular function of the ST elevation group was improved considerably after AC bypass surgery, while those of the ST depression group showed no improvement.
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