The "angina-producing" myocardial segment: An approach to the interpretation of results of coronary bypass surgery

Stephen C Achuff, Lawrence S C Griffith, C. Richard Conti, J. O Neal Humphries, Robert K. Brawley, Vincent L Gott, Richard S. Ross

Research output: Contribution to journalArticle

Abstract

The first 153 cases of saphenous vein aortocoronary bypass surgery performed at The Johns Hopkins Hospital were reviewed. Eighty-eight percent of the 140 late survivors reported significant symptomatic improvement. Seventy-one unselected patients consented to complete reevaluation at a mean interval of 6.1 months postoperatively. Vein bypass patency in this group was 66 percent. Eighty-two percent of these 71 patients had improved performance on electrocardiographic stress testing. There were no significant differences between hemodynamic status on pre- and postoperative studies regardless of the status of vein bypass patency. Repeat coronary angiography revealed a 30 percent incidence of new total occlusions of the intrinsic coronary circulation. Segmental wall motion on ventriculography was improved in 12 percent, unchanged in 50 percent and decreased in 38 percent of the segments analyzed. Localized electrocardiographic changes compatible with myocardial damage developed in the immediate postoperative period in 45 of these patients (63 percent); in 38 of the 45, these changes corresponded to new angiographic abnormalities. Physiologic mechanisms underlying symptomatic improvement were sought by identification of an "angina-producing" myocardial segment. In most instances, alleviation of angina could be related to either: (1) a patent bypass graft into an unchanged intrinsic coronary artery with presumed increased blood flow to the distal coronary segment, or (2) occlusion of the bypass graft and the corresponding coronary artery with probable infarction of previously ischemic myocardium. Current criteria for the selection of patients undergoing coronary bypass surgery are reviewed in the light of these findings. It is concluded that relief of disabling angina is the major indication for surgery. Prevention of myocardial infarction and improvement in left ventricular function are at present less reliable objectives.

Original languageEnglish (US)
Pages (from-to)723-733
Number of pages11
JournalThe American Journal of Cardiology
Volume36
Issue number6
DOIs
StatePublished - 1975

Fingerprint

Patient Selection
Veins
Coronary Vessels
Transplants
Coronary Circulation
Saphenous Vein
Coronary Angiography
Left Ventricular Function
Postoperative Period
Coronary Artery Bypass
Infarction
Survivors
Myocardium
Hemodynamics
Myocardial Infarction
Incidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

The "angina-producing" myocardial segment : An approach to the interpretation of results of coronary bypass surgery. / Achuff, Stephen C; Griffith, Lawrence S C; Conti, C. Richard; Humphries, J. O Neal; Brawley, Robert K.; Gott, Vincent L; Ross, Richard S.

In: The American Journal of Cardiology, Vol. 36, No. 6, 1975, p. 723-733.

Research output: Contribution to journalArticle

@article{bdf447d817864099981fd8d9746d90fa,
title = "The {"}angina-producing{"} myocardial segment: An approach to the interpretation of results of coronary bypass surgery",
abstract = "The first 153 cases of saphenous vein aortocoronary bypass surgery performed at The Johns Hopkins Hospital were reviewed. Eighty-eight percent of the 140 late survivors reported significant symptomatic improvement. Seventy-one unselected patients consented to complete reevaluation at a mean interval of 6.1 months postoperatively. Vein bypass patency in this group was 66 percent. Eighty-two percent of these 71 patients had improved performance on electrocardiographic stress testing. There were no significant differences between hemodynamic status on pre- and postoperative studies regardless of the status of vein bypass patency. Repeat coronary angiography revealed a 30 percent incidence of new total occlusions of the intrinsic coronary circulation. Segmental wall motion on ventriculography was improved in 12 percent, unchanged in 50 percent and decreased in 38 percent of the segments analyzed. Localized electrocardiographic changes compatible with myocardial damage developed in the immediate postoperative period in 45 of these patients (63 percent); in 38 of the 45, these changes corresponded to new angiographic abnormalities. Physiologic mechanisms underlying symptomatic improvement were sought by identification of an {"}angina-producing{"} myocardial segment. In most instances, alleviation of angina could be related to either: (1) a patent bypass graft into an unchanged intrinsic coronary artery with presumed increased blood flow to the distal coronary segment, or (2) occlusion of the bypass graft and the corresponding coronary artery with probable infarction of previously ischemic myocardium. Current criteria for the selection of patients undergoing coronary bypass surgery are reviewed in the light of these findings. It is concluded that relief of disabling angina is the major indication for surgery. Prevention of myocardial infarction and improvement in left ventricular function are at present less reliable objectives.",
author = "Achuff, {Stephen C} and Griffith, {Lawrence S C} and Conti, {C. Richard} and Humphries, {J. O Neal} and Brawley, {Robert K.} and Gott, {Vincent L} and Ross, {Richard S.}",
year = "1975",
doi = "10.1016/0002-9149(75)90452-X",
language = "English (US)",
volume = "36",
pages = "723--733",
journal = "American Journal of Cardiology",
issn = "0002-9149",
publisher = "Elsevier Inc.",
number = "6",

}

TY - JOUR

T1 - The "angina-producing" myocardial segment

T2 - An approach to the interpretation of results of coronary bypass surgery

AU - Achuff, Stephen C

AU - Griffith, Lawrence S C

AU - Conti, C. Richard

AU - Humphries, J. O Neal

AU - Brawley, Robert K.

AU - Gott, Vincent L

AU - Ross, Richard S.

PY - 1975

Y1 - 1975

N2 - The first 153 cases of saphenous vein aortocoronary bypass surgery performed at The Johns Hopkins Hospital were reviewed. Eighty-eight percent of the 140 late survivors reported significant symptomatic improvement. Seventy-one unselected patients consented to complete reevaluation at a mean interval of 6.1 months postoperatively. Vein bypass patency in this group was 66 percent. Eighty-two percent of these 71 patients had improved performance on electrocardiographic stress testing. There were no significant differences between hemodynamic status on pre- and postoperative studies regardless of the status of vein bypass patency. Repeat coronary angiography revealed a 30 percent incidence of new total occlusions of the intrinsic coronary circulation. Segmental wall motion on ventriculography was improved in 12 percent, unchanged in 50 percent and decreased in 38 percent of the segments analyzed. Localized electrocardiographic changes compatible with myocardial damage developed in the immediate postoperative period in 45 of these patients (63 percent); in 38 of the 45, these changes corresponded to new angiographic abnormalities. Physiologic mechanisms underlying symptomatic improvement were sought by identification of an "angina-producing" myocardial segment. In most instances, alleviation of angina could be related to either: (1) a patent bypass graft into an unchanged intrinsic coronary artery with presumed increased blood flow to the distal coronary segment, or (2) occlusion of the bypass graft and the corresponding coronary artery with probable infarction of previously ischemic myocardium. Current criteria for the selection of patients undergoing coronary bypass surgery are reviewed in the light of these findings. It is concluded that relief of disabling angina is the major indication for surgery. Prevention of myocardial infarction and improvement in left ventricular function are at present less reliable objectives.

AB - The first 153 cases of saphenous vein aortocoronary bypass surgery performed at The Johns Hopkins Hospital were reviewed. Eighty-eight percent of the 140 late survivors reported significant symptomatic improvement. Seventy-one unselected patients consented to complete reevaluation at a mean interval of 6.1 months postoperatively. Vein bypass patency in this group was 66 percent. Eighty-two percent of these 71 patients had improved performance on electrocardiographic stress testing. There were no significant differences between hemodynamic status on pre- and postoperative studies regardless of the status of vein bypass patency. Repeat coronary angiography revealed a 30 percent incidence of new total occlusions of the intrinsic coronary circulation. Segmental wall motion on ventriculography was improved in 12 percent, unchanged in 50 percent and decreased in 38 percent of the segments analyzed. Localized electrocardiographic changes compatible with myocardial damage developed in the immediate postoperative period in 45 of these patients (63 percent); in 38 of the 45, these changes corresponded to new angiographic abnormalities. Physiologic mechanisms underlying symptomatic improvement were sought by identification of an "angina-producing" myocardial segment. In most instances, alleviation of angina could be related to either: (1) a patent bypass graft into an unchanged intrinsic coronary artery with presumed increased blood flow to the distal coronary segment, or (2) occlusion of the bypass graft and the corresponding coronary artery with probable infarction of previously ischemic myocardium. Current criteria for the selection of patients undergoing coronary bypass surgery are reviewed in the light of these findings. It is concluded that relief of disabling angina is the major indication for surgery. Prevention of myocardial infarction and improvement in left ventricular function are at present less reliable objectives.

UR - http://www.scopus.com/inward/record.url?scp=0016753716&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0016753716&partnerID=8YFLogxK

U2 - 10.1016/0002-9149(75)90452-X

DO - 10.1016/0002-9149(75)90452-X

M3 - Article

C2 - 1081827

AN - SCOPUS:0016753716

VL - 36

SP - 723

EP - 733

JO - American Journal of Cardiology

JF - American Journal of Cardiology

SN - 0002-9149

IS - 6

ER -