Bourassa M G, Pepine C J, Forman S A, Rogers W J, Dyrda I, Stone P H, Chaitman B R, Sharaf B, Mahmarian J, Davies R F
Montreal Heart Institute, Quebec, Canada.
J Am Coll Cardiol. 1995 Sep;26(3):606-14. doi: 10.1016/0735-1097(95)00005-o.
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.
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.
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.
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).
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.
无症状性心脏缺血试验（ACIP）研究表明，在12周时，血运重建在抑制心脏缺血方面比药物治疗更有效。本报告比较了在ACIP研究中，冠状动脉血管成形术或冠状动脉旁路移植术在血运重建后2至3个月内抑制动态心电图（ECG）和跑步机运动心脏缺血方面的相对疗效。
先前的研究表明，冠状动脉血管成形术和旁路手术在很大比例的选定患者中可在术后早期缓解心绞痛。然而，血运重建后动态心电图和跑步机运动试验中缺血的缓解情况尚未得到充分的前瞻性研究。
在ACIP研究中随机分配接受血运重建的患者中，冠状动脉血管成形术或旁路手术的选择由临床科室工作人员和患者决定。
与接受血管成形术的患者（n = 92）相比，接受旁路手术的患者（n = 78）在基线时患有更严重的冠状动脉疾病（p = 0.001）和更多的缺血发作（p = 0.01）。血运重建后8周（入组后12周），旁路手术组70%的患者动态心电图缺血消失，而血管成形术组为46%（p = 0.002）。运动心电图上的ST段压低在旁路手术组46%的患者中消失，而血管成形术组为23%（p = 0.005）。跑步机运动试验的总运动时间（分钟）在旁路手术后增加了2.4分钟，在血管成形术后增加了1.4分钟（p = 0.02）。在12周就诊前的4周内，旁路手术组只有10%的患者仍报告有心绞痛，而血管成形术组为32%（p = 0.001）。
血运重建后早期，很大比例的患者心绞痛和动态心电图缺血得到缓解。然而，在许多患者中，尽管运动水平较高，跑步机运动试验仍可诱发缺血。尽管接受旁路手术的患者冠状动脉疾病更严重，但旁路手术在抑制心脏缺血方面优于冠状动脉血管成形术。
