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New hope for those with the most serious kind of pain.

We did not intend to devote this entire issue to the subject of pain, as important as it is, but a study recently reported in the American Journal of Cardiology may give new hope to some of our readers.

Because of the risk of serious complications, coronary artery bypass surgery is usually not advised for the very elderly. However, patients with coronary artery disease so severe that they have pain even at rest, not relieved by medication, have no other choice. Those who have had a recent heart attack likewise have no alternative. Without bypass surgery, their risk is greater than the risk of surgery.

A study at Duke University, reported on September 1, 1992, evaluated the performance status and outcome after coronary artery bypass grafting (CABG) in persons aged 8093 years. It involved all 86 patients on whom CABG surgery was performed at Duke, a major cardiac surgery center.

All of the cases were operated on as a "last resort," having been taken directly to surgery from the coronary care unit or cardiac catheterization laboratory because they were too ill to wait for elective surgery. Twenty-seven percent had had a heart attack within the past month, and 84 percent had angina at rest or during only mild activity.

Twenty-nine percent of them had serious complications from the surgery, and 14 percent died while still in the hospital (compared to a less than 2 percent mortality rate from CABG surgery in younger patients). However, the 74 patients who survived the surgery experienced a marked improvement in their quality of life. Although all of them had been too sick to be at home before surgery, 66 of them went directly home from the hospital; the other eight went to nursing homes. Those who went home were able to care for most of their own personal needs. Survival and good outcome were more common in the female patients than in the males.

CABG surgery has become so commonplace that it is often routinely performed on persons with coronary artery blockage, even with minor or no symptoms. Much criticism of this widespread use of cardiac surgery is now being voiced within the medical profession, most recently in the November 4 Journal of the American Medical Association. Second and even third opinions are being advised for patients whose physicians recommend bypass surgery. Nonetheless, for the elderly for whom there is no other recourse, the Duke study demonstrates how valuable CABG surgery can be when the indications are clear-cut.
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Copyright 1992 Gale, Cengage Learning. All rights reserved.

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Title Annotation:coronary artery disease
Publication:Medical Update
Date:Dec 1, 1992
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