Thirty-two patients with unstable angina treated medically over an average period of 48 months were studied prospectively. Hemodynamics, angiography, early and late incidence of nonfatal myocardial infarction and death, and symptomatic status were evaluated. Twenty-one patients considered "operable" (group I) were compared with 11 patients considered "inoperable" (group II). Operability was determined by coronary arteriography and left ventriculography. First year mortality for the entire group was 12.5 per cent, but it was 9.5 per cent in group I compared to 18 per cent in group II. There were no additional deaths in group I, but three year mortality increased to 36 per cent in group II. In patients with poor left ventricular function (ejection fraction < 30 per cent and end-diastolic volume index >125 cc/m2), the first year mortality was 29 per cent and the three year mortality 57 per cent. The incidence of nonfatal myocardial infarction during the follow-up period was 14 per cent in group I and 27 per cent in group II. There was no difference in symptomatic status between the patients in group I and group II, but in 50 per cent of the patients their condition remained class III or worse. These data suggest that the prognosis in medically treated operable patients with unstable angina (group I) is better than that in medically treated nonoperable patients (group II) with poor left ventricular function. Comparisons of the results of medical and surgical therapy of patients with unstable angina should be made only between operable patients.
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