Coronary heart disease and bypass surgery in urban blacks.

Myocardial revascularization was reviewed in 56 urban black patients (41 men, 15 women). The age range was 33 to 70 with a mean of 53. Fifty percent presented with class III angina and 50 percent had progressed to severe unstable angina. Cardiac catheterization revealed severe triple-vessel disease in 75 percent of the patients while 15 percent had double-vessel disease and only 9 percent had single-vessel disease.At surgery the average number of bypass grafts performed was 2.3. The operative mortality was 3.4 percent for the group with stable angina and 15 percent for the unstable group.At follow-up, 73 percent of the patients had no angina. Sixteen percent were improved and 11 percent continued to have angina. In spite of the presence of advanced coronary artery disease, myocardial revascularization can be accomplished with acceptable operative risks and good results in symptomatic urban blacks. The risk, however, is higher in patients who have already progressed to unstable angina. It is therefore imperative that operative intervention be carried out at an earlier stage of the disease if satisfactory results are to be realized in this group.