Author/Authors :
Martial G. Bourassa، نويسنده , , Carl J. Pepine، نويسنده , , Sandr A. Forman، نويسنده , , William J. Rogers، نويسنده , , Ihor Dyrda، نويسنده , , Peter H. Stone، نويسنده , , Bernard R. Chaitman، نويسنده , , Barry Sharaf، نويسنده , , John Mahmarian، نويسنده , , Richard F. Davies، نويسنده , , Genell L. Knatterud، نويسنده , , Michael Terrin، نويسنده , , George Sopko، نويسنده , , C. Richard Conti، نويسنده , , ACIP Investigators، نويسنده ,
Abstract :
Objectives
The Asymptomatic Cardiac Ischemi Pilot (ACIP) study showed that revascularization is more effective than medical therapy in suppressing cardiac ischemi at 12 weeks. This report compares the relative efficacy of coronary angioplasty or coronary artery bypass graft surgery in suppressing ambulatory electrocardiographic (ECG) and treadmill exercise cardiac ischemi between 2 and 3 months after revascularization in the ACIP study.
Background
Previous studies have shown that coronary angioplasty and bypass surgery relieve angin early after the procedure in high proportion of selected patients. However, alleviation of ischemi on the ambulatory ECG and treadmill exercise test have not been adequately studied prospectively after revascularization.
Methods
In patients randomly assigned to revascularization in the ACIP study, the choice of coronary angioplasty or bypass surgery was made by the clinical unit staff and the patient.
Results
Patients assigned to bypass surgery (n = 78) had more severe coronary disease (p = 0.001) and more ischemic episodes (p = 0.01) at baseline than those assigned to angioplasty (n = 92). Ambulatory ECG ischemi was no longer present 8 weeks after revascularization (12 weeks after enrollment) in 70% of the bypass surgery group versus 46% of the angioplasty group (p = 0.002). ST segment depression on the exercise ECG was no longer present in 46% of the bypass surgery group versus 23% of the angioplasty group (p = 0.005). Total exercise time in minutes on the treadmill exercise test increased by 2.4 min after bypass surgery and by 1.4 min after angioplasty (p = 0.02). Only 10% of the bypass surgery group versus 32% of the angioplasty group still reported angin in the 4 weeks before the 12-week visit (p = 0.001).
Conclusions
Angin and ambulatory ECG ischemi are relieved in high proportion of patients early after revascularization. However, ischemi can still be induced on the treadmill exercise test, albeit at higher levels of exercise, in many patients. Bypass surgery was superior to coronary angioplasty in suppressing cardiac ischemi despite the finding that patients who underwent bypass surgery had more severe coronary artery disease.
