Effects of myocardial revascularisation in patients with effort angina and those with effort and nocturnal angina

Abstract

The effects of coronary bypass graft operation were studied in 32 patients with daytime ambulatory ST segment changes and 14 patients with daytime and nocturnal angina and ST segment changes. Patients had ambulatory ST segment monitoring and excercise testing before and after operation and coronary arteriography was repeated in 34 patients after operation. Before operation, patients with daytime and nocturnal ischemia tended to have more severe coronary artery disease, lower excercise tolerance, and more frequent ambulatory ST segment changes than those who had daytime ST segment changes only. After operation chest pain recurred in 22% of patients and ST segment depression during excercise testing or ambulatory ST segment monitoring recurred in 37% of the patients and was significantly more frequent in those with nocturnal ischemia than in those with daytime ischemia. Graft patency rates were similar in patients with and those without recurrence of ischemia. After operation the frequency and magnitude of ST segment changes and excercise duration were improved in patients with preoperative daytime angina and also in those with daytime and nocturnal angina. The improvement was more pronounced in the latter groups. Thus, absence of postoperative angina is not a reliable indicator of the absence of reversible myocardial ischemia. After revascularisation, patients with rest and nocturnal angina can expect relief from ischemia, and if this recurs postoperatively, the threshold is improved and pain usually occurs only on exertion.