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[Symptomatic and silent myocardial ischemia during drug therapy and after aortocoronary bypass]
Insights
Complete coronary artery bypass surgery significantly improves exercise capacity and reduces myocardial ischemia in stable angina patients compared to medication. Incomplete revascularization shows limited benefits, and silent ischemia can persist post-surgery.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Internal Medicine
Background:
- Stable angina pectoris management often involves anti-ischemic medication and surgical revascularization.
- Coronary artery bypass grafting (CABG) aims to restore blood flow to the myocardium.
- Assessing the comparative efficacy of complete versus incomplete revascularization is crucial for patient outcomes.
Purpose of the Study:
- To compare the effectiveness of complete versus incomplete myocardial revascularization after aortocoronary bypass.
- To evaluate the impact of revascularization on exercise tolerance and myocardial ischemia.
- To assess the role of anti-ischemic medication versus surgical intervention in managing stable angina.
Main Methods:
- Prospective study involving 53 patients with stable angina pectoris.
- 24-hour ambulatory electrocardiographic monitoring (Holter) and bicycle ergometry performed pre- and post-surgery.
- Patients divided into complete (Group A, n=31) and incomplete (Group B, n=22) revascularization groups.
Main Results:
- Complete revascularization (Group A) significantly improved exercise duration (p < 0.01), reduced ST depression (p < 0.05), and decreased anginal episodes (p < 0.01) compared to medication.
- Incomplete revascularization (Group B) showed no significant improvement in these parameters.
- Revascularization eliminated ischemia during load in 61% of Group A patients vs. 14% in Group B (p=n.s.).
- Silent myocardial ischemia (ST depressions) was more frequent in Group B (6±8 episodes) than Group A (1±2 episodes) post-surgery.
Conclusions:
- Complete myocardial revascularization is significantly more effective than anti-ischemic medication for stable angina patients.
- Incomplete revascularization offers limited benefits in improving exercise tolerance and suppressing ischemia.
- Silent myocardial ischemia is common after CABG, particularly in incomplete revascularization cases, necessitating careful consideration.
Abstract:
In 53 patients with stable angina pectoris 24-hour ambulatory electrocardiographic monitoring (Holter) and bicycle ergometry were used before and six months after a coronary bypass. The examination before operation was made while anti-ischaemic medication was administered, the examination after revascularization was done without medication. The patients were divided into group A (31 patients where complete revascularization of the myocardium was made) and group B (22 patients with incomplete revascularization) and the results were compared during medication and after aortocoronary bypass. In patients of group A revascularization prolonged significantly the load period during ergometry, as compared with medication (from 7.2 +/- 2.2 min. to 9.1 +/- 2.4 min., p < 0.01), the depression of the ST segment in lead V5 was reduced (from 1.3 +/- 0.8 mm to 0.8 +/- 1.0 mm, p < 0.05) and the number of painful episodes during Holter monitoring (from 1 +/- 1 to 0, p < 0.01). In patients of group B none these parameters improved. Medicamentous treatment eliminated ischaemia during a load in 16% of patients in group A, while revascularization did so in 61% (p < 0.01). In patients of group B the success rate of medication was 9%, in revascularization 14% (p = n.s.). During Holter monitoring after revascularization no episodes of ST depressions associated with anginous pain were recorded, although the mean number of silent episodes of ST depressions per 24 hours was 6 +/- 8 in patients of group B and 1 +/- 2 in patients of group A. In patients with stable angina pectoris complete revascularization is significantly more effective than anti-ischaemic medication as regards tolerance of loads and suppression of myocardial ischaemia. Silent myocardial ischaemia is frequent after aortocoronary bypasses and its possible occurrence should be taken into account, in particular in patients with incomplete revascularization.