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[Effect of myocardial revascularization on asymptomatic ischemic episodes]
H Pierri1, M Wajngarten, J B Serro-Azul
1Instituto do Coração do hospital das Clínicas - FMUSP.
Insights
Coronary artery bypass graft surgery (CABG) effectively eliminated asymptomatic ischemic episodes in most patients. Persistent episodes after CABG may indicate graft occlusion, warranting further investigation.
Area of Science:
- Cardiovascular Surgery
- Ischemic Heart Disease Research
- Cardiac Electrophysiology
Context:
- Stable angina patients often experience asymptomatic ischemic episodes (IAE) despite medication.
- Ambulatory electrocardiography is crucial for detecting IAE.
- Microcirculation abnormalities were excluded in this study cohort.
Purpose:
- To assess the impact of coronary artery bypass graft surgery (CABG) on asymptomatic ischemic episodes (IAE).
- To determine if CABG influences the frequency and heart rate response of IAE.
Summary:
- A study of 28 male patients with stable angina showed a significant reduction in IAE post-CABG (from 162 to 4 episodes).
- Complete revascularization was achieved in 75% of patients.
- Postoperative IAE in two patients was linked to aortocoronary graft obstruction.
Impact:
- CABG successfully eliminated IAE in the majority of patients, irrespective of heart rate response.
- The presence of IAE after CABG suggests potential graft occlusion.
- This finding aids in diagnosing and managing post-CABG ischemia.
Purpose:
To evaluate the effect of coronary artery bypass graft surgery (CABG) on ischemic asymptomatic episodes (IAE).
Methods:
Twenty eight males (means age 57.3 +/- 9.6 years) with stable angina and no microcirculation abnormalities, who presented with IAE after medication withdrawal, were studied using ambulatory electrocardiography monitoring. Presence of IEA was analyzed before and 4 months after CABG according to its frequency and heart rate (HR) response. CAGB was considered complete in 75% of the cases.
Results:
The number or IAE was reduced from 162 (9 symptomatic) in the preoperative period to 4 after surgery (p < 0.05). In two patients with IAE in the postoperative period, coronariography confirmed obstruction of aortocoronary grafts. Analysis of HR at the beginning and peak of IAE suggested as mechanisms both reduced blood flow and increased oxygen consumption by the myocardium.
Conclusion:
CABC eliminated IAE regardless of HR. When IAE is present after surgery, graft occlusion should be suspected.