Beneficial effects of cardiac rehabilitation in patients with incomplete revascularization after primary coronary angioplasty.

BACKGROUND: There are no reliable data concerning the safety and benefits of physical rehabilitation in patients with a two-vessel disease before the second stage of angioplasty. The aim of this study was to evaluate the efficiency of early cardiac rehabilitation in patients with acute coronary syndromes and with angiographically significant residual coronary artery stenosis after a successful percutaneous coronary intervention (PCI) into the culprit lesion. DESIGN: Retrospective analysis of the results of coronary angiograms and exercise tests of patients who underwent stationary rehabilitation after their first ACS and first PCI. SETTING: Cardiac Rehabilitation Department. POPULATION: One hundred ninety patients divided into 2 groups according to the completeness of myocardial revascularization; 49 with significant (≥70%) coronary artery stenosis in a non-culprit vessel, the mean diameter reduction 80±9%; and 141 without any residual stenosis. The prevalence of classical risk factors was comparable in both groups. Rehabilitation was conducted as a stationary 3-week program. METHODS: Comparison of the initial and final exercise test workload in both groups, as well as the frequency of adverse effects during the program. RESULTS: Physical training in patients with incomplete revascularization (IR) was safe and well tolerated. Significant increase of workload capacity after the rehabilitation program was observed in both groups: in the IR group from 7.3±3.0 to 8.8±2.9 MET (P<0.0001) and in the complete revascularization (CR) group - from 7.6±2.8 to 9.2±2.9 MET (P<0.0001). No significant difference was observed in initial workload capacities (P=0.9813) nor in final workload capacities (P=0.8571) between the two groups. Two patients in the group with residual lesion (4%) and one in the group without residual lesion (0.7%) required urgent PCI during the rehabilitation program, P=0.1637. CONCLUSION: Early postinfarction physical training is safe and efficient for patients after complete revascularization and for those with untreated non-culprit coronary artery stenosis. Gradual increase in physical training intensity under cardiologist supervision is essential in identifying those rare patients for whom the second stage of angioplasty should not be delayed. CLINICAL REHABILITATION IMPACT: Our study shows that patients with incomplete revascularization may be qualified for cardiac rehabilitation programs.

[Can the exercise test with nitroglycerin be useful for differentiation of patients with and without changes in coronary arteries--syndrome X?]. / Czy próba wysilkowa z uzyciem nitrogliceryny moze byc przydatna w róznicowaniu chorych ze zmianami i bez zmian w naczyniach wiencowych--zespól X?

UNLABELLED: The aim of this study was to compare the results of ECG exercise test performed before and after oral administration of nitroglycerine (NTG) in patients with coronary artery disease (CAD), and patients with typical chest pain without any changes in coronary arteriography--syndrome X. We examined 98 patients with typical chest pain, positive result of ECG exercise test, then accordingly to results of coronary arteries assessed with coronary arteriography, patients (pts.) were divided into two groups: group 1--35 pts. without any changes in coronary arteriography--syndrome X, and group 2--48 pts. with significant stenosis present in one or more coronary vessels. Each patient underwent two ECG exercise tests: first without any medication and second performed average 30 minutes after first test, and 5 min after oral administration of 1 table of nitroglycerine. During both tests the following parameters were evaluated: test duration, presence of chest pain, max. ST-T changes, heart rate (HR), and systolic blood pressure (SBP). RESULTS: In group 1 after NTG time of test duration had shortened from 5.9 +/- 0.4 min to 5.7 +/- 0.6 min. We also observed an increase in max. ST-T complex depression (2.2 +/- 0.5 mm vs 2.4 +/- 0.4 mm) but these differences were not statistically significant. In CAD group, duration of test after NTG was longer (6.2 +/- 1 vs 7.4 +/- 1.2), and normalization of max. ST-T complex depressions (2.7 +/- 0.5 vs 2.0 +/- 0.3 mm) was observed p < 0.01. CONCLUSION: Our study suggests that ECG exercise test with NTG may be useful in differentiation of patients with syndrome X and patients with typical coronary artery disease.

Ischaemic episodes detected by early exercise test and Holter monitoring after myocardial infarction: which are of most prognostic value?

BACKGROUND: The aim of this study was to assess the significance of ST-segment depressions (ST-SD) detected during exercise test or Holter monitoring and to determine which parameters of ST-SD are the most important prognostic factors in patients after myocardial infarction. METHODS: The study group consisted of 164 patients (126 men and 38 women) who survived their first uncomplicated myocardial infarction. Twenty-four-hour Holter monitoring on day 10 (+/- 2) after infarction and a treadmill exercise test 1 or 2 days later were performed. The following parameters of ST-SD were taken into consideration: amplitude, localization according to the area of infarction and presence or absence of concomitant angina. Patients were observed for 24 months to assess the occurrence of new cardiac events. RESULTS: In 78 patients (group I) ST-SD were detected in both Holter monitoring and the exercise test, and in 32 patients (group II) in the exercise test only. Fifty-four patients (group III) were without ST-SD. During follow-up there were 83 cardiac events in group I, 24 in group II and 16 in group III (P < 0.01, group I versus II; P < 0.0001, group I versus III; P < 0.05, group II versus III). In multivariate analysis the presence of ST-SD during Holter monitoring or the exercise test, or both, appeared to be of most prognostic significance (P < 0.0001). The number of new cardiac events was significantly higher in patients with painful ST-SD greater than 3 mm, detected outside the area of infarction (distant ischaemia). CONCLUSIONS: This study shows a significant prognostic value of early post-infarction ischaemia detected by Holter monitoring and an exercise test. Distant, painful ST-SD greater than 3 mm were more powerful determinants of poor prognosis than others. Electrode placement during Holter monitoring appears to be very important, particularly in post-infarction patients.

[Comparison of the effectiveness of olicard 40 retard and cardonit 40 prolongatum preparations in treatment of stable coronary heart disease]. / Porównanie skutecznosci preparatów Olicard 40 retard i Cardonit 40 prolongatum w leczeniu stabilnej choroby wiencowej.

The purpose of the work was a comparison of the effectiveness of representatives of two subgroups of nitrates: Olicard 40 (isosorbide mononitrate) and Cardonit 40 (isosorbide dinitrate) in the treatment of ischaemic heart disease. The studied group consisted of 52 patients with stable coronary heart disease who were given for 30 days according to "blind trial" rules either Cardonit 40 or Olicard 40 in single daily dose. The effects of the treatment were monitored, assessing the parameters during three exercise tests and two 24-hour records by the Holter method. The advantage of Olicard 40 was demonstrated, expressed by higher effectiveness in the treatment of coronary heart disease (especially its "silent" form) without development of tachyphylaxis and with lower per cent of adverse reactions.

[Heart rupture in the course of acute transmural myocardial infarction]. / Pekniecie serca w przebiegu ostrego, pelnosciennego zawalu serca.

The purpose of the work was an assessment of the incidence of heart rupture as the complication of acute transmural myocardial infarction, and establishing of risk factors. In a retrospective study, among 150 patients hospitalized in the department in the years 1982-1992 and dying in the course of acute transmural myocardial infarction, in whom postmortem examination was done, 19 cases complicated with heart rupture were found. The analysis was carried out on the basis of autopsy results and clinical documentation. The studied group included 12 women (63.2%) and 7 men (36.8%). Most frequently encountered were ruptures of the free wall of the left ventricle (n = 12). The risk factors are: age over 60 years, female sex, arterial hypertension, left ventricular hypertrophy and the first myocardial infarction without earlier coronary complaints.