Surgical treatment of unstable angina: Indications and results

Unstable angina pectoris is a broad, non-specific diagnosis associated to a variable degree of acute myocardial infarction. Different classifications of unstable angina have been proposed, and they are based on the anatomo-pathological, angiographic and clinical picture or on the efficacy of the medical treatment. The purpose of this study is to review the results of urgent and elective surgical myocardial revascularization in a group of patients with unstable angina. Between January 1989 and December 1992, 27 patients have been admitted to our Center, with diagnosis of unstable angina. All of them had previously received medical treatment with betablockers, calcium-antagonists, intravenous nitroglycerin and heparin. Nine patients (33.3%), with persistent angina refractory to the medical therapy, needed urgent revascularization, while 18 patients (66.7%), responsive to the medical treatment, received elective revascularization, after two weeks from the beginning of the symptoms. Complications included perioperative myocardial infarction in 3 patients (11.1%) and postoperative low cardiac output syndrome in 4 (14.8%). One patients (5.5%), who underwent urgent operation, died of refractory arrhythmias, and one patient (5.5%) died of complications of low cardiac output syndrome, after elective revascularization. The surgical treatment of unstable angina, even if presenting worst results compared to those obtained in patients with stable angina, remains the only possible therapy when the medical treatment fails.