The surgical treatment of coronary heart disease: a review and critique of the literature.

In the United States, heart disease is the leading cause of death, outranking malignancies, accidents, pneumonia, and tuberculosis. One of every two persons will die of some form of heart disease. This increase in incidence, making it the number one killer in the nation, is both relative and absolute: as the infectious diseases are being brought more and more under control, and the standard of living and the life expectancy of the average American are steadily climbing, the insidious and chronic diseases become more prominent. Statistics, however, clearly show that there has beeu an absolute rise in the incidence of heart disease over the past 20 years or so. The direct cause of this rise is the greatly increased incidence of coronary heart disease. Since 1930, with the exclusion of coronary disease, heart disease has steadily decreased, whereas coronary disease per se has rapidly increased. As our understanding and hence, symptomatic treatment of coronary heart disease have improved, the relative prognosis of people suffering from this condition has improved. In 25 year follow-up studies of 200 patients with myocardial infarctions, and 456 with angina pectoris, Richards, Bland and White’ have reported the following: the average survival of patients from the onset of angina pectoris symptoms is about 10 years; 76 per cent of these patients die of cardiac causes. Angina pectoris does decrease the average life expectancy, but not exceptionally so; in other words, at any given age, 7 per cent of men and 5.3 per cent of women with angina pectoris, in addition to the predicted mortality of the population at large, will die. Turning to myocardial infarction, the average survival time is five years, considering the total number of patients. Those who completely recover from the initial attack, however, have an average survival rate of better than 10 years.