Objectives: The Asymptomatic Cardiac Ischemia Pilot (ACIP) study showed that revascularization is more effective than medical therapy in suppressing cardiac ischemia 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 ischemia between 2 and 3 months after revascularization in the ACIP study.
Background: Previous studies have shown that coronary angioplasty and bypass surgery relieve angina early after the procedure in a high proportion of selected patients. However, alleviation of ischemia 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 ischemia 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 angina in the 4 weeks before the 12-week visit (p = 0.001).
Conclusions: Angina and ambulatory ECG ischemia are relieved in a high proportion of patients early after revascularization. However, ischemia 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 ischemia despite the finding that patients who underwent bypass surgery had more severe coronary artery disease.
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http://dx.doi.org/10.1016/0735-1097(95)00005-o | DOI Listing |
BMC Neurol
January 2025
Department of Neurosurgery, Gifu University Graduate School of Medicine, 1-1, Yanagido, Gifu, 501-1194, Japan.
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H+ Yangji Hospital, Seoul, Republic of Korea.
Background: Although bariatric surgery is the most effective obesity treatment, few nationwide cohort studies have evaluated its safety. This study aimed to evaluate surgical trends after insurance coverage implementation and analyze the surgical outcomes of bariatric surgery.
Methods: A retrospective analysis of bariatric surgery in patients with obesity was conducted using data from Korean National Health Insurance System (NHIS) claims.
J Int Med Res
January 2025
Department of Surgery, Chonnam National University Hospital, Gwangju, Republic of Korea.
The popliteal artery segment is particularly challenging for endovascular treatment. Stents used for treating popliteal artery lesions are usually associated with an increased risk of stent fracture and re-occlusion. The Supera stent is designed to withstand mechanical stress, with a low risk of fracture.
View Article and Find Full Text PDFAnimal Model Exp Med
January 2025
Urology and Nephrology Research Center, Research Institute of Urology and Nephrology, Shahid Labbafinejad Medical Center, Urology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
This study developed an animal model with internal and external urethral sphincter insufficiency by bypassing the sphincter without major damage so that the animal under study can return to normal life after the study. There is a need for a reliable, applicable, and reproducible animal model for studying urinary incontinency disease due to incorrect sphincter function. Seven adult male dogs were used for this study.
View Article and Find Full Text PDFJ Chest Surg
January 2025
Department of Thoracic and Cardiovascular Surgery, oneDOC Co. Ltd., Seoul, Korea.
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