Effect of medical vs surgical treatment on symptoms in stable angina pectoris. The Veterans Administration Cooperative Study of surgery for coronary arterial occlusive disease.

The comparative effect of medical vs surgical treatment on symptoms in patients with stable angina has been evaluated in a large-scale randomized study. We obtained systematic information regarding symptoms and medication requirements by questionaire, and a scoring system was devised to provide an index of severity. Data are available on 384 patients who had an entry questionnaire, 639 with an annual questionnaire and 329 who had both an entry and a 1-year questionnaire. A severe degree of angina and associated symptoms were present at entry. Symptoms were similar in both treatment groups at entry. At 1 year, surgical patients had a significant improvement in symptoms. Approximately 60% had marked improvement or were free of angina, compared with 16% of patients treated medically. Only 14% of surgical patients were unchanged or worse at 1 year, compared with 56% of medical patients. These results are comparable to those reported by other studies that have examined the effect of surgical vs medical treatment of angina. Surgical patients in the Veterans Administration Study took substantially less daily medication at 1 year, while medical patients took moderately more. Relief of symptoms in surgical patients was related to graft patency, and patients who had all grafts patent had the most striking improvement. In 29 patients with all grafts closed, symptoms were significantly less severe at 1 year than in patients who took medical treatment. A placebo effect or an undetermined effect of surgery on pain may explain this phenomenon.