TMai 31a.p65

Mailing address: Anellys Emilia Lourenço da Costa Moreira Rua Cincinato Braga, 102 01333-010 São Paulo, SP Brazil E-mail: [email protected] Sent for publishing on 11/17/2004 Accepted on 12/03/2004 Approximately 60% of the patients with multivessel coronary artery disease and indication for myocardial revascularization can, technically, be treated both through surgical myocardial revascularization (SMR) and through percutaneous coronary transluminal angioplasty (CTA). However, the diversity of coronary lesions, the diameter of ill-taken arteries, the extension of myocardial ischemia and the ill-taking of left ventricular function makes difficult the choice among the methods, which emphasize the need of performance of comparative studies among them. Despite all benefits achieved by these two therapeutic models, randomized and controlled clinical studies involving SMR and CTA in patients with multivessel coronary artery disease could not establish a consensus concerning the procedure with long term better clinical results, with many clinical, angiographic and prognostic conditions related to them being under questioning1-9. The world literature is rich in data that demonstrate that the presence of exercise-induced perfusion myocardial changes provide more accurate information than those obtained through anatomic data interpreted through cinecoronariography: angiographically similar coronary lesions can have different functional meanings10,11. Therefore, the main determining factor of the evolution of coronary artery disease would be represented by the functional meaning of the lesion (repercussion on myocardial perfusion), and the identification of ischemia would make possible to intervene in the natural history of the disease: maybe, the desirable complete myocardial revascularization (absence of residual coronary lesion greater than 70% in any large epicardial ramus after CTA or in accordance to the number of distal anastomoses performed through SMR in vessels regarded as ill) would be excessively valued to the detriment of functionally suitable myocardial revascularization8-10,12,13. So, the residual level of myocardial ischemia after SMR or CTA could explain and correlate the results found in many studies with the characteristics of the patients submitted to each procedure. However, there is a scarce of information concerning the effect of those procedures of revascularization on myocardial ischemic load. So, this study aims at analyzing and quantifying previous (moment 1 – M1) and later (moment 2 – M2; 6 months) myocarObjective To assess the myocardial ischemic load to previous and after myocardial revascularization.