Abstract
To assess the effects of standard therapeutic interventions on the total ischemic burden, 86 patients with stable angina underwent 48 hours of ambulatory ST segment monitoring and treadmill exercise testing before and at a mean of 10 weeks after coronary artery bypass surgery (CABG) (group 1, N = 46) or percutaneous transluminal coronary angioplasty (PTCA) (group 2, N = 40). There were 72 male and 14 female patients with a mean age of 56.4 years. All patients had documented coronary artery disease (24, single-vessel; 28, two-vessel; 34, three-vessel disease). Both groups were characteristically similar apart from more severe coronary artery disease ( p < 0.001) and more previous myocardial infarctions ( p < 0.05) in group 1. Groups with CABG and PTCA had significant prolongation of exercise time after intervention (group 1: 7.6 to 9.8 minutes, p < 0.0001; group 2: 8.1 to 10.0 minutes, p < 0.001), and both interventions led to a significant reduction in ischemic responses (group 1: 33 to 4, p < 0.001; group 2: 20 to 13, p < 0.05) to exercise. During a total of 7643 hours of ST segment monitoring, 253 episodes of ischemia were recorded in 3768 hours before and 44 ischemic episodes in 3875 hours after intervention (group 1, 113 episodes in 24 patients and 21 episodes in 10 patients; group 2, 140 episodes in 13 patients and 23 episodes in six patients). Both interventions reduced the mean frequency of ischemia per 24 hours (group 1: 1.24 to 0.22 episodes per 24 hours; p < 0.01; group 2: 1.9 to 0.3 episodes per 24 hours; p < 0.05). Almost 28% (N = 24) of resting electrocardiographic findings were altered as a result of intervention. Both CABG and PTCA are effective in improving exercise capacity and reducing the total ischemic burden. The paucity of transient ischemic episodes after these interventions and the frequency of alteration of the baseline electrocardiogram as a result of intervention make the use of ambulatory ST segment monitoring of questionable practical usage as an additional tool to assess the effects of revascularization and make interpretation of the ST segment more difficult in some instances.
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