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Abstract
The studies on natural history of ischemic heart disease are reviewed and the major
predictors of mortality identified. The severity of the coronary atherosclerosis and
the status of ventricular function are found to be more important predictors of survival
than the clinical presentation. The objectives of therapy in patients with ischemic
heart disease are (1) to improve the quality of life by reducing symptoms, (2) to
improve ventricular function, and (3) to increase survival time. The results of surgical
therapy are examined in relation to these three objectives.
Symptomatic improvement is present in 85 to 95 percent of patients after surgery,
but convincing evidence for improved ventricular function is lacking and controlled
studies of natural history have failed to show that surgery increases survival time.
Analysis of the mechanism of symptomatic improvement after surgery suggests that increased
blood flow to the ischemic area as well as infarction of ischemic myocardium and the
nonspecific effects of surgery may account for the improvement. The prevention of
coronary atherosclerosis is viewed as an attainable long-term solution to the problem
of ischemic heart disease.
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Article info
Footnotes
☆This paper was presented as the opening plenary address at the 24th Annual Scientific Session of the American College of Cardiology, Houston, Texas, February 10, 1975. The research upon which this publication is based was performed pursuant to Contract N01 HL 71444 from the National Institutes of Health, Department of Health, Education, and Welfare, Bethesda, Md.
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Copyright
© 1975 Published by Elsevier Inc.
