Persistent improvement after coronary bypass surgery: ergometric and angiographic correlations at 5 years.

One hundred patients with angina pectoris who fulfilled specific entry criteria were randomly assigned to either medical therapy or bypass surgery. These groups were subjected to annual exercise testing during a 5-year follow-up period. The degree of revascularization was assessed by graft and native vessel angiography at 3 weeks, 1 year and 5 years after the operation. The exercise tolerance of the medical group remained largely unchanged during the follow-up. Eighty-five to 95% of the patients were using beta-blocking compounds at the successive testing situations. The surgical group exhibited a sustained improvement in exercise tolerance: Total work increased by 39-66% (p less than 0.02-0.001) and maximal ergometric load by 23-35% (p less than 0.01-0.001), and maximal ST depression decreased by 39-61% (p less than 0.05-0.001). The use of beta-blocking compounds in the surgical group steadily increased, from 44% at 6 months after operation to 63% of patients at 5 years. Division of the surgical group into subsets of complete and incomplete revascularization revealed that the improvement was confined to complete revascularization. Thus, the improved exercise tolerance after bypass surgery was a result of successful reestablishment of effective coronary perfusion; despite graft attrition (15% in 5 years) and new lesions in the native arteries, this improvement persisted for 5 years with appropriate medical therapy.

RCT Entities:   Population Interventions Outcomes