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[Effects of coronary surgery on silent ischemia]
J M Calqueiro1, P Adragão, D Martins
1Serviço de Cardiologia, Hospital de Santa Cruz, Carnaxide.
Insights
Coronary artery bypass surgery significantly reduced angina and ischemia. However, silent myocardial ischemia persisted in over a third of patients post-surgery, requiring ongoing monitoring.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Context:
- Stable chronic angina pectoris affects many patients.
- Coronary artery bypass surgery (CABG) is a common treatment.
- Silent myocardial ischemia (SMI) poses a significant risk.
Purpose:
- To evaluate the impact of CABG on SMI.
- To assess changes in angina and ischemia markers post-surgery.
Summary:
- 39 patients with stable angina underwent CABG.
- Pre- and post-operative assessments included 48-hour Holter monitoring and treadmill exercise tests.
- Angina reduced by 92% and ischemia by 57% post-CABG.
- SMI was present in 54% pre-op and 36% post-op.
- No new cases of SMI developed.
Impact:
- SMI can persist even after successful CABG for angina relief.
- Continued monitoring for SMI via Holter recordings is recommended.
- Medical management of persistent SMI may be necessary.
Abstract:
In order to assess the effects of coronary artery bypass surgery on silent myocardial ischemia, we studied a group of 39 consecutive patients, 38 male and 1 female with a mean age of 56 + 7 years, with stable chronic angina pectoris, by 48 hours-Holter monitoring and maximal treadmill exercise test before and after operation. The reduction of angina was 92% (p less than 0.0001) and of ischemia 57% (p less than 0.0001) after operation. Silent myocardial ischemia was detected in 21 patients (54%) before operation, 13 by Holter, 4 by exercise test and 4 by the two methods. After operation 13 patients (36%) continue to have silent ischemia depicted in 7 by Holter and in 7 by exercise test. No new patient developed silent ischemia after operation. The group of patients with silent ischemia preoperatively was not significantly different from the group without silent ischemia based on clinical and angiographic characteristics, results of surgery and exercise test parameters with exception of ST segment depression. In conclusion, silent myocardial ischemia may persist after successful coronary artery bypass surgery for the relief of angina pectoris, and should be monitored by serial Holter recordings and treated medically, if its prognosis and consequences proved to be similar to manifest symptomatic ischemia.