BACKGROUND. Balloon-expandable coronary-artery stents were developed to prevent coronary restenosis after coronary angioplasty. These devices hold coronary vessels open at sites that have been dilated. However, it is unknown whether stenting improves long-term angiographic and clinical outcomes as compared with standard balloon angioplasty. METHODS. A total of 520 patients with stable angina and a single coronary-artery lesion were randomly assigned to either stent implantation (262 patients) or standard balloon angioplasty (258 patients). The primary clinical end points were death, the occurrence of a cerebrovascular accident, myocardial infarction, the need for coronary-artery bypass surgery, or a second percutaneous intervention involving the previously treated lesion, either at the time of the initial procedure or during the subsequent seven months. The primary angiographic end point was the minimal luminal diameter at follow-up, as determined by quantitative coronary angiography. RESULTS. After exclusions, 52 patients in the stent group (20 percent) and 76 patients in the angioplasty group (30 percent) reached a primary clinical end point (relative risk, 0.68; 95 percent confidence interval, 0.50 to 0.92; P = 0.02). The difference in clinical-event rates was explained mainly by a reduced need for a second coronary angioplasty in the stent group (relative risk, 0.58; 95 percent confidence interval, 0.40 to 0.85; P = 0.005). The mean (+/- SD) minimal luminal diameters immediately after the procedure were 2.48 +/- 0.39 mm in the stent group and 2.05 +/- 0.33 mm in the angioplasty group; at follow-up, the diameters were 1.82 +/- 0.64 mm in the stent group and 1.73 +/- 0.55 mm in the angioplasty group (P = 0.09), which correspond to rates of restenosis (diameter of stenosis, > or = 50 percent) of 22 and 32 percent, respectively (P = 0.02). Peripheral vascular complications necessitating surgery, blood transfusion, or both were more frequent after stenting than after balloon angioplasty (13.5 vs. 3.1 percent, P < 0.001). The mean hospital stay was significantly longer in the stent group than in the angioplasty group (8.5 vs. 3.1 days, P < 0.001). CONCLUSIONS. Over seven months of follow-up, the clinical and angiographic outcomes were better in patients who received a stent than in those who received standard coronary angioplasty. However, this benefit was achieved at the cost of a significantly higher risk of vascular complications at the access site and a longer hospital stay.

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A Comparison of Balloon-Expandable-Stent Implantation with Balloon Angioplasty in Patients with Coronary Artery Disease

The purpose of this report is to provide revised standards and guidelines for the exercise testing and training of individuals who are free from clinical manifestations of cardiovascular disease and those with known cardiovascular disease. These guidelines are intended for physicians, nurses, exercise physiologists, specialists, technologists, and other healthcare professionals involved in exercise testing and training of these populations. This report is in accord with the “Statement on Exercise” published by the American Heart Association (AHA).1

These guidelines are a revision of the 1995 standards of the AHA that addressed the issues of exercise testing and training.2 An update of background, scientific rationale, and selected references is provided, and current issues of practical importance in the clinical use of these standards are considered. These guidelines are in accord with the American College of Cardiology (ACC)/AHA Guidelines for Exercise Testing.3

### The Cardiovascular Response to Exercise

Exercise, a common physiological stress, can elicit cardiovascular abnormalities that are not present at rest, and it can be used to determine the adequacy of cardiac function. Because exercise is only one of many stresses to which humans can be exposed, it is more appropriate to call an exercise test exactly that and not a “stress test.” This is particularly relevant considering the increased use of nonexercise stress tests.

### Types of Exercise

Three types of muscular contraction or exercise can be applied as a stress to the cardiovascular system: isometric (static), isotonic (dynamic or locomotory), and resistance (a combination of isometric and isotonic).4,5 Isotonic exercise, which is defined as a muscular contraction resulting in movement, primarily provides a volume load to the left ventricle, and the response is proportional to the size of the working muscle mass and the intensity of exercise. Isometric exercise is defined as a muscular contraction without movement (eg, handgrip) and imposes greater pressure than volume …

Exercise Standards for Testing and Training A Scientific Statement From the American Heart Association

Jeffrey L. Anderson, MD, FACC, FAHA, Chair 

Jonathan L. Halperin, MD, FACC, FAHA, Chair-Elect 

Alice K. Jacobs, MD, FACC, FAHA, Immediate Past Chair 2009–2011 [§§][1]

Sidney C. Smith, Jr, MD, FACC, FAHA, Past Chair 2006–2008 [§§][1]

Cynthia D. Adams, MSN, APRN-BC, FAHA[§§][1]

Nancy M

2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons.

The American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions (ACC/AHA/SCAI) 2005 Guideline Update for Percutaneous Coronary Intervention (PCI) contains changes in the recommendations, along with supporting text. For the purpose of comparison

https://cdr.lib.unc.edu/downloads/k3569637k

ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention-summary article : A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention)

Guidelines for Percutaneous Transluminal Coronary Angioplasty. A Report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Subcommittee on Percutaneous Transluminal Coronary Angioplasty)

During electrophysiologic study in a patient, programmed stimulation of the atrium induced fixed coupled ventricular premature beats on the basis of intraventricular macroreentry. This type of macroreentry, which was reproducible, appears to have been merely a "laboratory curiosity" and never played a clinical role in this patient with chronic recurrent ventricular tachycardia.

Macroreentry as a mechanism of atrial-induced ventricular ectopic beats: a laboratory curiosity?

This case report illustrates the value of electrophysiologic study in patients presenting with graphically unmonitored syncope and/or sudden cardiac death, and who have clinical markers of both bradycardia and ventricular tachycardia. In our patient, a wide QRS on the electrocardiogram and Holter monitor documented high grade ventricular ectopic activity. In this case, had therapy been solely guided by the clinical impression that the patient had ventricular tachycardia, the treatment would have resulted in increasing the risk of recurrence of syncope and/or sudden cardiac death.

Cardiac syncope: a case exhibiting dichotomy between clinical impression and electrophysiologic evaluation.

This report describes a patient who presented with transient central nervous system symptoms of unknown etiology with an electro-cardiogram exhibiting a narrow QRS complex and normal. P-R interval. The decision to implant a permanent VII pacemaker was made on the basis of a His bundle study that revealed significant prolongation of the HV interval. The successful clinical outcome re-emphasizes the clinical usefulness of electrophysiological investigation in patients with syncope of undetermined etiology.

An Indication for His Bundle Study: Syncope, a Normal P‐R Interval and a Narrow QRS

Coronary reconstruction in a patient with prior renal transplantation: a case report with long-term follow-up.

A VVI pacemalter was permanently implanted for the purpose of suppressing recurrent ventricular tachycardia (VT). Not only did the device fail to suppress the VT, but also the permanent endocardial electrode caused a second VT which was more rapid and clinically more severe. When a new VT occurs in the presence of a permanently implanted ventricular pacing system, the implanted electrode should he considered as one of the possible etiologic causes for the VT.

Arthur J. Gosselin

Papers

Macroreentry as a mechanism of atrial-induced ventricular ectopic beats: a laboratory curiosity?

Cardiac syncope: a case exhibiting dichotomy between clinical impression and electrophysiologic evaluation.

An Indication for His Bundle Study: Syncope, a Normal P‐R Interval and a Narrow QRS

Coronary reconstruction in a patient with prior renal transplantation: a case report with long-term follow-up.

A permanently implanted endocardial electrode complicating ventricular tachycardia with a second VT.