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(Circulation. 1974;49:606.)
© 1974 American Heart Association, Inc.

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The Nature of Treatment Selection in Coronary Artery Disease

Experience with Medical and Surgical Treatment of a Chronic Disease

J. FREDERICK MCNEER M.D.¹; C. FRANK STARMER PH.D.¹; ALAN G. BARTEL M.D.¹; VICTOR S. BEHAR M.D.¹; YIHONG KONG M.D.¹; ROBERT H. PETER M.D.¹; ROBERT A. ROSATI M.D.¹

¹ From the Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina.

This report presents our experience with the medical and surgical management of patients with coronary heart disease and uses this experience to document the role of a computerized medical information system in the long-term management of patients with a chronic disease. Of 781 consecutively evaluated patients, 402 were treated medically and 379 were treated with aortocoronary bypass surgery. At two years post-zero time, more than twice as many surgical survivors were pain free, but the survival was the same in the medical (83%) and surgical (85%) cohorts. The medically and surgically treated patients were compared with respect to 89 baseline characteristics. The cohorts were remarkably similar. Correction for baseline inequalities did not affect the fact that two-year survival was the same in both cohorts. One subgroup was identified in which surgically treated patients had a higher two-year survival. Other subgroups were identified in which therapy did not appear to affect two-year survival.

Key Words: Data bank • Follow-up studies • Prognostic stratification • Angina pectoris • Aortocoronary bypass

Submitted on September 19, 1973
Accepted on December 20, 1973

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