Treatment of preinfarction angina with intraaortic balloon counterpulsation and surgery

Sixteen patients with preinfarction angina unresponsive to medical therapy were treated by Counterpulsation with the intraaortic balloon pump. Chest pain and electrocardiographic changes were abolished or significantly decreased in all but one patient. Counterpulsation reduced peak systolic blood pressure, but had little effect on pulmonary capillary wedge pressure or cardiac output. Coronary anatomy was then defined by coronary angiography. Significant obstructive atherosclerosis of the main left or left anterior descending coronary artery was present in all but one patient. All patients underwent coronary revascularization by saphenous vein aortocoronary bypass graft. Fifteen of 16 patients survived the operation. All survivors are clinically improved, and 13 are completely asymptomatic from 1 to 20 months postoperatively.