Medical and Surgical Treatment for Unstable Angina

To the Editor; The recent report by Luchi et al. (April 16 issue),¹ describing the results of a Veterans Administration cooperative study comparing medical and surgical treatment for unstable angina pectoris, is similar to earlier articles cited by the authors. However, the authors suggest that “the survival of patients with unstable angina and an abnormal left ventricular ejection fraction at rest is improved by coronary-artery bypass surgery.” Of the medically treated patients in this study, only 62.9 percent were receiving long-acting nitrates, and 62.1 percent propranolol. Calcium-channel–blocking agents had not yet been approved for use in unstable angina pectoris when…