Skip to main content
NCBI home page
British Heart Journal logoLink to British Heart Journal
. 1975 Oct;37(10):1053–1058. doi: 10.1136/hrt.37.10.1053

Acute coronary insufficiency. An urgent surgical condition.

R M Lawson, R Chapman, J Wood, A Starr
PMCID: PMC482918  PMID: 1081399

Abstract

In 41 of 220 consecutive patients who had a coronary artery bypass operation between July 1973 and March 1974 the operation was for acute coronary insufficiency (recurrent chest pain with transient electrocardiographic changes persisting after admission to hospital). Their mean age was 54 (range 33-70 years). Eleven patients had had angina before, 14 had had at least one myocardial infarction, and 16 presented de novo. Eight of the latter 16 patients required only a single graft, usually to the left anterior descending artery, a significantly greater number than the two of the other 25 patients (P less than 0.01). Fourteen of these 16 patients had normal ventricular contraction, a significantly higher proportion than the 13 of the remaining 25 (p less than 0.05). No collaterals were seen in any of the 10 with single-vessel disease, which was significantly fewer than five out of 18 with double- and nine out of 13 with triple-vessel disease (P less than 0.005). Patients with rapidly developing obstruction, especially in the proximal left anterior descending artery, may not have time to develop collaterals, present acutely with good ventricular function, and may be particularly at risk. There was no operative mortality. The patients had a perioperative myocardial infarction, and there was one late death. At follow-up averaging 9-7 months (range 5-14 months) 32 (80%) patients were angina-free, no myocardial infarctions had occurred, and 85% were fully employed. Urgent coronary artery bypass grafting is a safe and effective treatment for acute coronary insufficiency.

Full text

PDF
1053

Images in this article

1054Image
on p.1054

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson R. P., Hodam R., Wood J., Starr A. Direct revascularization of the heart. Early clinical experience with 200 patients. J Thorac Cardiovasc Surg. 1972 Mar;63(3):353–359. [PubMed] [Google Scholar]
  2. Bonchek L. I., Rahimtoola S. H., Anderson R. P., McAnulty J. A., Rosch J., Bristow J. D., Starr A. Late results following emergency saphenous vein bypass grafting for unstable angina. Circulation. 1974 Nov;50(5):972–977. doi: 10.1161/01.cir.50.5.972. [DOI] [PubMed] [Google Scholar]
  3. Fowler N. O. "Preinfarctional" angina. A need for an objective definition and for a controlled clinical trial of its management. Circulation. 1971 Nov;44(5):755–758. doi: 10.1161/01.cir.44.5.755. [DOI] [PubMed] [Google Scholar]
  4. Gazes P. C., Mobley E. M., Jr, Faris H. M., Jr, Duncan R. C., Humphries G. B. Preinfarctional (unstable) angina--a prospective study--ten year follow-up. Prognostic significance of electrocardiographic changes. Circulation. 1973 Aug;48(2):331–337. doi: 10.1161/01.cir.48.2.331. [DOI] [PubMed] [Google Scholar]
  5. Goodin R. R., Inglesby T. V., Lansing A. M., Wheat M. W., Jr Preinfarction angina pectoris. A surgical emergency. J Thorac Cardiovasc Surg. 1973 Dec;66(6):934–942. [PubMed] [Google Scholar]
  6. Judkins M. P. Percutaneous transfemoral selective coronary arteriography. Radiol Clin North Am. 1968 Dec;6(3):467–492. [PubMed] [Google Scholar]
  7. Proudfit W. L., Shirey E. K., Sones F. M., Jr Distribution of arterial lesions demonstrated by selective cinecoronary arteriography. Circulation. 1967 Jul;36(1):54–62. doi: 10.1161/01.cir.36.1.54. [DOI] [PubMed] [Google Scholar]
  8. Scanlon P. J., Nemickas R., Moran J. F., Talano J. V., Amirparviz F., Pifarre R. Accelerated angina pectoris. Clinical, hemodynamic, arteriographic, and therapeutic experience in 85 patients. Circulation. 1973 Jan;47(1):19–26. doi: 10.1161/01.cir.47.1.19. [DOI] [PubMed] [Google Scholar]
  9. Thomas C. S., Jr, Alford W. C., Jr, Burrus G. R., Stoney W. S. Aorta-to-coronary artery bypass grafting. Indications and contraindications--an interim review. Ann Thorac Surg. 1973 Aug;16(2):201–215. doi: 10.1016/s0003-4975(10)65838-9. [DOI] [PubMed] [Google Scholar]
  10. VAKIL R. J. PREINFARCTION SYNDROME--MANAGEMENT AND FOLLOW-UP. Am J Cardiol. 1964 Jul;14:55–63. doi: 10.1016/0002-9149(64)90106-7. [DOI] [PubMed] [Google Scholar]
  11. WOOD P. Acute and subacute coronary insufficiency. Br Med J. 1961 Jun 24;1(5242):1779–1782. doi: 10.1136/bmj.1.5242.1779. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Wilson W. S. Aortocoronary saphenous vein bypass: a review of the literature. Heart Lung. 1973 Jan-Feb;2(1):90–103. [PubMed] [Google Scholar]
  13. Zeft H. J., Manley J. C., Huston J. H., Tector A. J., Auer J. E., Johnson W. D. Left main coronary artery stenosis; results of coronary bypass surgery. Circulation. 1974 Jan;49(1):68–76. doi: 10.1161/01.cir.49.1.68. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES