Document Detail

Effects of an early invasive strategy on ischemia and exercise tolerance among patients with unstable coronary artery disease.
MedLine Citation:
PMID:  14656612     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: An early invasive approach after an episode of unstable coronary artery disease has beneficial effects on mortality and myocardial infarction, but its effects on exercise capacity and ischemia have not been investigated. METHODS: In the Fast Revascularisation during InStability in Coronary disease (FRISC) II trial, 2457 patients with unstable coronary artery disease were assigned randomly to an early invasive or noninvasive strategy. A symptom-limited bicycle exercise test was performed before discharge in the noninvasive group and after 3 months in both groups. RESULTS: At 3 months, 86% (1046/1222) of the patients in the invasive group and 81% (995/1235) in the noninvasive group performed the exercise test. Before the test, revascularization had been performed in 78% (n = 819) of these patients in the invasive group compared with 28% (n = 281) of those in the noninvasive group. The mean (+/- SD) exercise capacity was higher (6.4 +/- 1.9 vs. 6.2 +/- 1.9 metabolic equivalents [METS], P <0.01), and the occurrence of ischemia lower (23% [229/1004] vs. 36% [352/966], P <0.001) in the invasive group. In the noninvasive group, 882 patients performed an exercise test both predischarge and at 3 months. If a revascularization procedure was performed (n = 210), exercise tolerance increased from 5.1 +/- 1.4 to 6.0 +/- 1.8 METS (P <0.001) and the number of patients with ST depression decreased from 65% (131/203) to 31% (63/203) (P <0.001). Without revascularization (n = 670), exercise tolerance increased from 5.9 +/- 2.2 to 6.3 +/- 1.9 METS (P <0.001), and there were no differences in the occurrence of ischemia. CONCLUSION: In unstable coronary artery disease, an invasive strategy improves exercise tolerance and reduces exercise-induced ischemia.
Erik Diderholm; Bertil Andrén; Gunnar Frostfeldt; Margareta Genberg; Tomas Jernberg; Bo Lagerqvist; Bertil Lindahl; Lars Wallentin
Publication Detail:
Type:  Clinical Trial; Clinical Trial, Phase II; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of medicine     Volume:  115     ISSN:  0002-9343     ISO Abbreviation:  Am. J. Med.     Publication Date:  2003 Dec 
Date Detail:
Created Date:  2003-12-05     Completed Date:  2004-01-08     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  606-12     Citation Subset:  AIM; IM    
Department of Cardiology, University Hospital, Uppsala, Sweden.
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MeSH Terms
Angina, Unstable / etiology,  therapy
Coronary Angiography
Dalteparin / therapeutic use
Exercise Test*
Exercise Tolerance*
Fibrinolytic Agents / therapeutic use
Middle Aged
Myocardial Ischemia / complications,  diagnosis*,  therapy*
Myocardial Revascularization*
Predictive Value of Tests
Recovery of Function
Treatment Outcome
Reg. No./Substance:
0/Dalteparin; 0/Fibrinolytic Agents
Comment In:
Am J Med. 2003 Dec 1;115(8):669-71   [PMID:  14656622 ]

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