SUMMARY We evaluated changes in ventricular wall motion after surgery by comparing smoothed, filtered measurements of regional percent shortening (RPS) from right anterior oblique ventriculograms in 37 patients before and after surgery. After surgery there was a significant (p < 0.05) decrease in the number of regions with hypokinetic wall motion. The distribution of RPS values was also different (p < 0.005). However, the mean value of RPS for the surgery group as a whole was not significantly altered. These data were contrasted with RPS data from 11 control patients, who were each studied twice but did not have surgical intervention. Similar analysis of the control group did not show any significant change between studies in the number of hypokinetic regions, and the distributions of RPS for the first and second angiograms were not different. We found a 10.3% absolute mean change in repeated measurements of RPS in the control group. We conclude that significant changes occurred after surgery that were not evident in the control group, and the amount of variability in repeated measurements of RPS suggests that analysis should be applied to group rather than individual data.
For a group of 658 patients who received coronary artery bypass graft surgery, we investigated the correlation between the degree of early (6 months) graft patency and recurrence of anginal symptoms, late myocardial infarction, and postoperative coronary-related death. The patients were grouped according to the number of surgically placed grafts, and each group was further subgrouped on the basis of the number of grafts functioning at the early postsurgical follow-up examination. The patients were observed over a period as long as 13 years. The frequency with which angina returned correlated significantly with the degree of patency within each of the groups (one, two, three, or four grafts); patients with a higher percentage of patent grafts experienced longer periods of freedom from angina. On the average, patients with all of their multiple grafts patent experienced at least 7 more years of symptomatic relief than their counterparts with all grafts occluded. Most surprisingly, the rate of the return of angina for those patients who had all grafts patent and were completely revascularized was independent of the number of diseased vessels or the number of grafts placed. The findings for coronary death and postoperative infarction showed similar trends. Circulation 69, No. 3, 569-576, 1984. NUMEROUS investigations have been conducted to compare the efficacy of surgical as opposed to medical treatment for coronary artery disease.`A Surgery is often considered the treatment of choice even for patients in whom it cannot be shown that the procedure prolongs life because of the potential for improved quality of life. Because many decisions are based on an expected decrease in morbidity, we investigated the relationship between early surgical success measured by graft patency and long-term outcome: return of anginal symptoms and incidence of late postoperative myocardial infarction, as well as late postoperative coronaryrelated death. MethodsThe records of the 658 patients who underwent coronary bypass graft surgery were entered in a computerized data base and analyzed by the HELP system for medical decision-making. Subsequently, 32 (5%) of the 658 patients underwent a sec-
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