Coronary artery disease with minimal angina

This study retrospectively examines 447 patients with minimal or absent angina found to have significant coronary artery disease (CAD) by coronary arteriography. Patients with left main coronary stenosis, valvular heart disease, or ventricular aneurysm were excluded. Treatment choice was nonrandom—more medically treated patients had single-vessel disease, normal left ventricular contractility, or absence of angina. Isolated coronary artery bypass grafting (CABG) was performed in 284 patients; of 163 patients initially managed nonoperatively, 22 subsequently crossed over to surgical treatment because of increasing angina. Average followup is 38.6 months (range 18 to 64). There was an important, but not statistically significant, difference in the 3 year cumulative survival rate—surgical 98.3% (70% CL 97.6% to 100%) versus medical 94.1% (70% CL, 91.7% to 96.5%) p = 0.077. There was only one noncardiac death and there were three nonfatal myocardial infarctions in patients with single-vessel disease, regardless of therapy. In patients with multivessel disease, the 3 year cumulative survival rate was significantly better in the surgical (98.6%) than the medical group (91.5%) p = 0.031. Event-free 3 year survival rate (death, myocardial infarction, crossover to surgical therapy, or reoperation) was significantly better in surgically treated patients overall (90.4% versus 73.5%, p = 0.000041), as well as in surgically treated patients with double- or triple-vessel disease taken as separate subsets. Angina relief was also significantly better with surgical treatment (74.6% versus 44.3%, p