Showing papers by "William G. Austen published in 1976"

Unstable angina pectoris: National cooperative study group to compare medical and surgical therapy: I. Report of protocol and patient population

Abstract: A preliminary report is presented of a prospective randomized trial conducted by eight cooperative institutions under the auspices of the National Heart and Lung Institute to compare the effectiveness of medical and surgical therapy in the management of the acute stages of unstable angina pectoris. To date 150 patients have been included in the randomized trial, 80 assigned to medical and 70 to surgical therapy; the clinical presentation, coronary arterial anatomy and left ventricular function in the two groups are similar. Some physicians have been reluctant to prescribe medical or surgical therapy by a random process, and the ethical basis of the trial has been questioned. Since there are no hard data regarding the natural history and outcome of therapy for unstable angina pectoris, randomization appears to provide a rational way of selecting therapy. Furthermore, subsets of patients at high risk may emerge during the process of randomization. The design of this randomized trial is compared with that of another reported trial. Thus far, the study has shown that it is possible to conduct a randomized trial in patients with unstable angina pectoris, and that the medical and surgical groups have been similar in relation to the variables examined. The group as a whole presented with severe angina pectoris, either as a crescendo pattern or as new onset of angina at rest, and 84 percent had recurrence of pain while in the coronary care unit and receiving vigorous medical therapy. It is anticipated that sufficient patients will have been entered into the trial within the next 12 months to determine whether medical or surgical therapy is superior in the acute stages of unstable angina pectoris.

Refractory angina pectoris: follow-up after intraaortic balloon pumping and surgery.

Abstract: Ffity-five patients with recurrent severe angina pectoris at rest that was resistant to medical therapy were treated with intraaortic balloon pumping (IABP), angiography, and vein bypass surgery. There were 25 patients with typical angina with ST depression during pain, 12 with Prinzmetal's angina, and 18 patients with angina in the early recovery phase following "transmural" myocardial infarction. The severity and frequency of ischemic attacks were documented with hemodynamic and continuous electrocardiographic monitoring. A marked reduction in both frequency and intensity of attacks was produced by IABP. Temporary cessation of IABP resulted in rapid recurrence of angina in 40% of patients. All underwent selective coronary angiography and revascularization surgery. The overall mortality was 5.5% and the incidence of intraoperative myocardial infarction was under 2%. Follow-up evaluation after an average of 18 months has shown no late deaths and sustained clinical improvement.

Intra-aortic balloon assist for cardiogenic shock and ischemic states at Massachusetts General Hospital.

Abstract: Intra-aortic balloon pumping is used at MGH for the reversal of acute myocardial ischemia in those patients not responding to usual medical means. The survival rate of surgical intervention in patients in cardiogenic shock was significantly increased in patients who had been balloon-pumped prior to surgery. The use of the intra-aortic balloon assist early in the postoperative patient showing low cardiac output state not only served to improve hemodynamics but also led to the preservation of the myocardium and ultimate improved survival. The balloon assist was initiated to control the ischemic states in patients with severe unstable angina. Used in association with nitroprusside and propranolol, this method produced marked improvement and reduction of pain in patients. Indications are that intra-aortic balloon counterpulsation at the present time is the safest and most predictable means of controlling acute ischemia in patients who are resistant to standard medical intervention.