The "natural" history of severe angina pectoris with intensive medical therapy alone: a five year prospective study of 133 patients.

A prospective study utilizing a comprehensive medical regimen is reported in 133 patients with severe angina pectoris due to coronary artery disease. Marked amelioration of pain, increase in exercise tolerance and improvement in ischemic exercise+lectrorardiographic patterns were observed in 90.2 percent of the patients in response to titrated doses of propranolol and sublingual isosorbide dinitrate administered coocomitantly. The prospects for five-year survival were found to be excellent in patients with good left ventricular function and no adverse clinical signs. The annual mortality in a group of 102 "good risk" patients was only 1.2 percent. In sharp contrast, the yearly attrition rate in subjects with poor left ventricular function approximated 25 percent. The findings indicate that severe angina pectoris which is refractory to casual methods of management frequently responds to an intensive program of optimal medical care. It is only when medical therapy has been pursued with a high degree of enthusiasm and intensity of purpose that the attending physician can gain insight into the true indications for surgical intervention in the various clinical subsets of angina pectoris. Surgical revascularization would appear to have limited application in the treatment of this disease.