A randomized comparison of elective high-pressure stenting with balloon angioplasty: six-month angiographic and two-year clinical follow-up. On behalf of AS (Angioplasty or Stent) trial investigators.

BACKGROUND: Previous randomized trials have shown beneficial effects of coronary stenting on restenosis and event-free survival rates. However, it has not yet been fully established if routine high-pressure stenting with an antiplatelet regimen can show similar results. METHODS: We compared the 6-month angiographic restenosis rate and 2-year event-free survival rate in 400 patients randomly assigned to stent or angioplasty. Aspirin and ticlopidine were prescribed in both groups. RESULTS: The procedural success rate did not significantly differ between the stent and angioplasty groups (97.92% vs 97.45%, P = not significant). No stent thrombosis was found. The 6-month restenosis rate was lower in the stent group (18. 18% vs 24.87%, P =.055). At 2 years target lesion revascularization rate was 17.19% in the stent group and 25.51% in the angioplasty group (P =.02, 33% reduction). No significant differences with regard to death and myocardial infarction were observed. Event-free survival rate at 6, 12, and 24 months was 86.77% vs 78.84%, 84.13% vs 76.70%, and 83.07% vs 73.54% for stent and angioplasty groups, respectively (P =.0172). CONCLUSIONS: The 6-month angiographic and 2-year clinical outcomes were better in patients who received stent than in those after balloon angioplasty. The difference in 2-year event-free survival rate was explained by a reduction in target lesion revascularization rate in the stent group.

Heart rate power spectral analysis in patients before and 6 weeks after coronary artery bypass grafting.

Decreased cardiac vagal activity is a known risk factor in coronary artery disease. The aim of our study was to determine the effect of coronary artery bypass grafting (CABG) on heart rate variability (HRV) before and 6 weeks after CABG. The study group consisted of 34 patients (4 women, 30 men, mean age 56 +/- 9 years). ECGs were recorded in 10 minutes periods in both supine and standing position with controlled breathing rate (0.25Hz). The analysis of HRV power spectrum was done by means of fast Fourier transformation. The total spectral power (TPS), power in very low frequency band (VLF: < 0.05 Hz), low frequency band (LF:0.05-0.15Hz), high frequency band (HF:0.15-0.5Hz), LF/HF ratio and percentage fraction of total power in these frequency bands (%VLF, %LF, %HF) were analysed. Significant attenuation of all spectral components of HRV were found during orthostatic load before CABG (p < 0.05). TPS, VLF, LF, %HF decreased in standing position to about half of their level in supine position, HF decreased to as little as one fourth, while LF/HF ratio and %LF increased significantly (p < 0.05). After the CABG these changes were not significant. We have found significant increase of HF (p < 0.05) and %HF (p < 0.01) in standing position after the CABG. The results suggest that CABG causes an improvement in cardiac vagal activity especially in standing position.