[Unstable angina pectoris: disease picture and study of its course].

The object of the present study is to analyse the history of patients with typical unstable angina. For this purpose the data of all patients admitted to the Hannover Medical School between 1977 and 1983 and taken to the CCU because of proven unstable angina (history, duration of symptoms, intrahospital mortality, incidence of infarction, medical or surgical therapy, coronary pathomorphology, mortality after release from hospital, late incidence of infarction and rehospitalization) were documented and stored on a data bank for statistical analysis. 123 patients were entered into the study (97 males, 26 females; average age 58.4 +/- 9.2 years); during hospitalization all patients had angina at rest, 94% had transient ECG-changes (ST-segment changes, BBB etc.). The average follow-up was 4.2 +/- 2.0 years. 80 patients of the whole study population were treated medically, 43 underwent early bypass surgery. The two groups were different with respect to coronary pathomorphology (number of diseased vessels) as well as left ventricular wall motion, which was significantly more impaired in the surgical group (p less than 0.05). The hospital-mortality in the surgical group amounted to 9.3% (n = 4), the incidence of infarction to 18.6% (n = 8); the hospital mortality in medically treated patients was 2.5% (n = 2), the incidence of infarction 7.5% (n = 6). During the whole study period (average follow-up 4.2 years) the overall mortality amounted to 21%, the infarction rate was 23.5%: The cumulative survival rates revealed no significant difference between the 2 groups: after 3 years 84% of all patients were still alive, 65% without new infarction during the observation period; the rate of rehospitalization amounted to 50%. At the end of the study class III or IV angina (NYHA-criteria) was much more common in the medically treated than in the surgically treated group (NYHA mean 2.5 versus 2.0; p less than 0.5). The relatively high rate of perioperative death and myocardial infarction in the surgical group is based on the selection of patients according to coronary pathomorphology and the clinical status.