BACKGROUND AND AIM: The Asymptomatic Cardiac Ischemia Pilot is the first randomized trial where revascularization involved choice of either coronary bypass or angioplasty used in an early or a delayed symptom-driven approach. One-year outcomes were favorable (reduced recurrent ischemia and adverse outcomes) for an early revascularization strategy (within 4 weeks), compared with an early medical strategy when revascularization was delayed until symptom-driven. This ancillary study examined variables influencing outcomes after these 2 revascularization approaches (early vs. delayed until symptom-driven). METHODS: Participants were clinically stable coronary disease patients with stress-induced and daily life ischemia who underwent revascularization. Characteristics associated with clinical outcomes occurring within the year following revascularization were examined using Cox regression analysis. RESULTS: A total of 262 patients received revascularization; 170 in the early approach and 92 in the delayed symptom-driven approach. Thirty-three patients had adverse outcomes (death, nonfatal myocardial infarction, or repeat revascularization) during 1-year follow-up. The most important independent predictor of improved outcome during the follow-up year was attempted revascularization of > or = 66% of vessels with significant stenosis for the early (risk ratio [RR] 0.25, 95% confidence interval [CI] 0.09-0.67) and the delayed (RR 0.21, CI 0.08-0.58) approaches. Factors such as age, stress test results, and coronary angiographic findings did not predict clinical outcome. CONCLUSIONS: Our findings are important in the planning of a large trial with longer follow-up.

Adult↗

PubMedDate not supplied

Quantitative analysis of nitroglycerin-induced coronary artery vasodilation in transplanted hearts.

Quantitative serial coronary angiograms performed annually over a 3-year period after transplantation in 26 orthotopic heart transplant recipients showed persistently normal nitroglycerin-induced vasodilation. The vasodilator response to nitroglycerin did not predict development of graft arteriopathy; the presence of graft arteriopathy did not prevent a substantial vasodilator response to nitroglycerin.

Adult↗

PubMedDate not supplied

Serial quantitative coronary angiography in the assessment of coronary disease in the transplanted heart.

Quantitative angiographic studies with use of cine-videodensitometry after maximal coronary vasodilation with nitroglycerin in 18 "angiographically normal" heart transplant recipients demonstrated significant loss of lumen diameter between years 1 and 3. When sensitive angiographic techniques are used, graft arteriopathy appears to be ubiquitous in heart transplant recipients.

Coronary Angiography↗

PubMedDate not supplied

Clinical and angiographic experience with intraoperative transluminal balloon-catheter dilatation and coronary artery bypass graft surgery.

Between April, 1980 and October, 1983, 40 patients with chronic stable angina pectoris underwent intraoperative transluminal balloon-catheter dilatation and coronary artery bypass graft (CABG) surgery. The main indication for this combined procedure was diffuse symptomatic coronary artery disease with at least one coronary artery having two or more areas of narrowing. Intraoperative dilatation was performed upon 42 coronary arteries involving 57 narrowed arterial segments where dilatation was attempted. The balloon-tipped catheter could not be passed through two stenotic sites. There was no documented perforation but unrecognized intimal injury was observed in two patients at postoperative catheterization. There was one perioperative myocardial infarction, one operative death and 97% early relief of angina pectoris. In 25 distal arterial narrowings that were studied angiographically in the early postoperative period (mean 10 days), 15 (60%) were unchanged, 2 (8%) were worse and 8 (32%) were improved compared to the preoperative angiogram. Patients with discrete narrowings did better than those who had balloon dilatation for diffuse narrowings; 49% of the former as compared to 17% of the latter had angiographic evidence for improvement. During the follow-up period (mean 30 months), three patients developed recurrent angina pectoris and one died of congestive heart failure. Thirteen distal arterial narrowings were studied angiographically late postoperatively (mean 12 months). In these 13 areas, 6 (46%) were unchanged, 3 (23%) were worse and 4 (31%) were improved compared to preoperative angiograms. Additionally, 10 arterial narrowings were observed angiographically, both early and late postoperatively. Nine of these serially observed segments remained unchanged while one became worse.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗

PubMedDate not supplied

Transluminal coronary angioplasty.

Explore the source record for details and available documents.

Aged↗

PubMedDate not supplied

Management of patients with unstable angina.

Explore the source record for details and available documents.

Angina Pectoris↗