EFFECT OF MEDICAL VS SURGICAL TREATMENT ON SYMPTOMS IN STABLE ANGINA-PECTORIS - VETERANS-ADMINISTRATION COOPERATIVE STUDY OF SURGERY FOR CORONARY ARTERIAL OCCLUSIVE DISEASE

被引:84
作者
PEDUZZI, P [1 ]
HULTGREN, HN [1 ]
机构
[1] VET ADM HOSP,CENT OFF,SERV MED RES,PROGRAM COOPERAT STUDIES,WASHINGTON,DC 20422
关键词
D O I
10.1161/01.CIR.60.4.888
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The comparative effect of medical vs surgical treatment on symptoms in patients with stable angina has been evaluated in a large-scale randomized study. We obtained systematic information regarding symptoms and medication requirements by questionnaire, and a scoring system was devised to provide an index of severity. Data are available on 384 patients who had an entry questionnaire, 639 with an annual questionnaire and 329 who had both an entry and a 1-year questionnaire. A severe degree of angina and associated symptoms were present at entry. Symptoms were similar in both treatment groups at entry. At 1 year, surgical patients had a significant improvement in symptoms. Approximately 60% had marked improvement or were free of angina, compared with 16% of patients treated medically. Only 14% of surgical patients were unchanged or worse at 1 year, compared with 56% of medical patients. These results are comparable to those reported by other studies that have examined the effect of surgical vs medical treatment of angina. Surgical patients in the Veterans Administration Study took substantially less daily medication at 1 year, while medical patients took moderately more. Relief of symptoms in surgical patients was related to graft patency, and patients who had all grafts patent had the most striking improvement. In 29 patients with all grafts closed, symptoms were significantly less severe at 1 year than in patients who took medical treatment. A placebo effect or an undetermined effect of surgery on pain may explain this phenomenon.
引用
收藏
页码:888 / 900
页数:13
相关论文
共 29 条
[1]   CHANGES IN WORKING STATUS OF PATIENTS FOLLOWING CORONARY-BYPASS SURGERY [J].
BARNES, GK ;
RAY, MJ ;
OBERMAN, A ;
KOUCHOUKOS, NT .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1977, 238 (12) :1259-1262
[2]   EFFECTS OF CORONARY-ARTERY BYPASS GRAFTING ON RESTING AND EXERCISE HEMODYNAMICS IN PATIENTS WITH STABLE ANGINA-PECTORIS - PROSPECTIVE, RANDOMIZED STUDY [J].
BARRY, WH ;
PFEIFER, JF ;
LIPTON, MJ ;
TILKIAN, AG ;
HULTGREN, HN .
AMERICAN JOURNAL OF CARDIOLOGY, 1976, 37 (06) :823-830
[3]   CHANGES IN EXERCISE PERFORMANCE FOLLOWING UNSUCCESSFUL CORONARY-ARTERY BYPASS GRAFTING [J].
BLOCK, T ;
ENGLISH, M ;
MURRAY, JA .
AMERICAN JOURNAL OF CARDIOLOGY, 1976, 37 (01) :122-122
[4]   GRADING OF ANGINA-PECTORIS [J].
CAMPEAU, L .
CIRCULATION, 1976, 54 (03) :522-523
[5]   QUANTITATIVE CLINICAL INDEX FOR DIAGNOSIS OF SYMPTOMATIC CORONARY-ARTERY DISEASE [J].
COHN, PF ;
VOKONAS, PS ;
WILLIAMS, RA ;
HERMAN, MV ;
GORLIN, R .
NEW ENGLAND JOURNAL OF MEDICINE, 1972, 286 (17) :901-&
[6]  
CONTI RC, 1977, CORONARY BYPASS SURG
[7]  
DAVID P, 1976, UNION MED CAN, V105, P1199
[8]  
DETRE K, 1977, AM J CARDIOL, V40, P212, DOI 10.1016/0002-9149(77)90011-X
[9]  
DETRE K, 1977, LANCET, V2, P1243
[10]   NEW CLINICAL TAXONOMY FOR RATING CHANGE IN FUNCTIONAL ACTIVITIES OF PATIENTS WITH ANGINA-PECTORIS [J].
FEINSTEIN, AR ;
WELLS, CK .
AMERICAN HEART JOURNAL, 1977, 93 (02) :172-182