Urgent surgical coronary bypass for acute coronary insufficiency resulted in 4.8% death and 14.3% MI versus 0% death and 10.5% MI with medical therapy, but improved functional capacity (P<0.01).
RCT (n=40)
randomly allotted
Does urgent surgical coronary bypass improve outcomes compared to medical therapy in patients with acute coronary insufficiency?
Initial medical management followed by elective bypass for continued angina is a reasonable alternative to emergency bypass in acute coronary insufficiency, despite better early functional capacity with surgery.
Absolute Event Rate: 4.8% vs 0%
Forty patients with acute coronary insufficiency, including continued angina at rest and reversible ischemic electrocardiographic changes after hospitalization ("high-risk" subgroup), were randomly allotted to medical therapy or urgent surgical coronary bypass groups. In four months there were no deaths and two myocardial infarctions in 19 medical patients and one death and three myocardial infarctions in 21 surgical patients. Left ventricular ejection fraction did not change significantly in either group. The surgical patients had significantly higher functional capacities at four months as judged by lower symptomatic functional class (P less than 0.01), higher exercise angina threshold (P less than 0.001), higher pacing angina threshold (P less than 0.0001), and higher myocardial lactate extraction during pacing (P less than 0.0001). Initial medical management of patients with acute coronary insufficiency followed by elective coronary bypass in patients with continued disabling angina pectoris is a reasonable alternative to emergency bypass.
Selden et al. (1975) conducted an RCT in Acute coronary insufficiency (n=40). Urgent surgical coronary bypass vs. Medical therapy was evaluated on Death. Urgent surgical coronary bypass for acute coronary insufficiency resulted in 4.8% death and 14.3% MI versus 0% death and 10.5% MI with medical therapy, but improved functional capacity (P<0.01).
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