scholarly journals Different tactics of single-stent endovascular treatment among coronary heart disease patients with coronary artery bifurcation lesions

2012 ◽  
Vol 11 (2) ◽  
pp. 39-43
Author(s):  
Z. Kh. Shugushev ◽  
Yu. V. Tarichko ◽  
Yu. A. Vasyuk
Keyword(s):  
Coronary Heart Disease ◽  
Blood Flow ◽  
Heart Disease ◽  
Coronary Artery ◽  
Balloon Angioplasty ◽  
Ecg Changes ◽  
Timi Grade ◽  
Group I ◽  
Bifurcation Lesions ◽  
Group Ii

Aim. To analyze the results of different tactics of single-stent endovascular treatment among patients with coronary heart disease (CHD) and coronary artery bifurcation lesions (CABL). Material and methods. The study included 135 CHD patients with CABL. All participants were divided into 2 groups: Group I (n=77; 58,3 %) consisted of patients who underwent coronary artery (CA) main branch (MB) stenting and subsequent kissing balloon angioplasty of a CA side branch (SB). Group II (n=55) included patients with “genuine” CABL, who underwent only MB stenting with SB protection, but without SB balloon angioplasty. Results. In all 132 CABL patients, drug-eluting stents were successfully implanted, with technical effectiveness of 100 % and in-hospital survival of 100 %. Clinical outcomes were similar in both groups, with no major cardiovascular events registered. At the same time, such an important angiographic index as SB diameter was significantly higher in Group I, compared to Group II. At later stages, Group II patients required SB angioplasty and demonstrated habitual angina symptoms, ischemic electrocardiographic (ECG) changes, and slow SB blood flow (TIMI grade <III) after CA MB stenting. Conclusion. MB stenting of CA bifurcation without SB kissing balloon angioplasty cannot be recommended to all CABL patients. Development of habitual angina symptoms, ischemic ECG changes, and slow SB blood flow (TIMI grade <III) often requires subsequent SB kissing balloon angioplasty.

scholarly journals Coronary artery status in patients with coronary heart disease and chronic obstructive pulmonary disease: results of selective coronary angiography

2012 ◽  
Vol 11 (5) ◽  
pp. 29-32
Author(s):  
N. Yu. Grigorieva ◽  
E. G. Sharavrin ◽  
A. N. Kuznetsov ◽  
T. V. Koroleva ◽  
P. A. Blinov ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Selective Coronary Angiography ◽  
Group I ◽  
Group Ii

Aim. To study the specifics of coronary artery pathology in patients with coronary heart disease (CHD) and chronic obstructive pulmonary disease (COPD), using the data of selective coronary angiography (CAG). Material and methods. In total, 907 CHD patients were examined. Group I included 251 participants with CHD and COPD; Group II included 656 individuals with CHD only. CAG was performed in 582 patients (64,2%): 184 from Group I (73,3%) and 398 from Group II (60,7%). Results. In patients with the combination of cardiac and pulmonary disease, the prevalence of two- and three-vessel pathology was higher, compared to CHD-only patients: 70,6% in Group I vs. 53,8% in Group II (p=0,002). In Group I, the Syntax Scale score was significantly higher than in Group II (24,7±4,1 vs. 18,7±3,1, respectively). Conclusion. Patients with combined cardiac and pulmonary pathology demonstrated a more severe coronary artery atherosclerosis, based on such CAG parameters as stenosis degree, number of involved vessels, size and location of lesions, and proximal stenosis.

scholarly journals Сompliance in patients with coronary heart disease and erosive-ulcerative gastroduodenopathy

2020 ◽  
pp. 82-87
Author(s):  
A. R. Molchanova ◽  
A. I. Dolgushina ◽  
A. A. Seljanina
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Rating Scale ◽  
Group I ◽  
Group Ii ◽  
Ulcerative Lesions ◽  
Artery Disease ◽  
Gastroduodenal Zone

Aim: To study the compliance features of patients with coronary artery disease and erosive-ulcerative lesions of the gastroduodenal zone.Methods: The study included 93 patients: 55 (59%) men and 38 (41%) women. Comorbidity indices Charlson, Kaplan-Feinstein and CIRS-G (Cumulative lllness Rating Scale for Geriatrics) system, anxiety and depression scores were calculated for all patients. The questionnaire Kadyrov R. V. et al. “The level of compliance was used to evaluate patient adherence. Statistical processing was performed using PAST (v. 3.21; Hammer et al., 2001) and MedCalc (v. 13.0; MedCalc®).Results: All patients are divided into two groups: group I—30 (32%) patients with coronary artery disease with erosive and ulcerative lesions of the stomach and duodenum, group II—63 (68%) patients with coronary artery disease without erosive-ulcerative gastroduodenopathies. We found significant intergroup differences in patients according to the CIRS-G and KAPLAN-FEINSTEIN comorbidity indices.In patients with coronary heart disease with erosive-ulcerative gastroduodenopathies the level of general compliance and its components was significantly higher than in patients without pathology of the gastroduodenal zone. It should be noted that high compliance according to the questionnaire was observed in 22 (73.3%) patients in group I and in 19 (30.2%) patients of group II (p <0.001), while with a low level of compliance—in 1 (3.3%) in group I and 17 (27.0%) in group II (p = 0.009). The level of compliance did not correlate with age, duration of disease, and comorbidity indices.Conclusion: In the study group of patients the frequency of erosive and ulcerative gastroduodenopathies was 32%. Patients with ischemic heart disease and erosive-ulcerative gastroduodenopathies are characterized by higher levels of compliance and anxiety. 

scholarly journals Results of holter monitoring in patients with coronary heart disease depending on the severity of atherosclerotic lesions of the coronary arteries

2021 ◽  
pp. 15-19
Author(s):  
Tetiana Pylova
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Comparative Analysis ◽  
Myocardial Ischemia ◽  
Coronary Arteries ◽  
Holter Monitoring ◽  
Group I ◽  
St Segment ◽  
Stable Coronary Heart Disease ◽  
Group Ii

The aim – to conduct a comparative analysis of the presence, frequency and duration of episodes of myocardial ischemia and arrhythmias based on the results of Holter monitoring in patients with coronary heart disease depending on the condition of the coronary arteries. Materials and methods. We examined 53 patients (group I) with stable coronary heart disease (CHD) and slightly altered coronary arteries (INOCA), who were hospitalized in the period from October 2018 to February 2021 at the “City Clinical Hospital № 8” of Kharkiv City Council. Group II included 52 patients with a diagnosis of stable coronary heart disease, and according to coronary angiography (CAG) had stenosis of coronary arteries (CA) more than 50 %. Results. According to the results of comparative analysis, it was found that in group I there were signs of myocardial ischemia – depression of the ST segment in 62.3 % (n=33) and elevation of the ST segment in 11.3 % (n=6), compared with group II -73 % (n=38) and 5.66 % (n=3), respectively. Ventricular arrhythmias (VA) have been reported in 52 patients of group I, and in 44 patients of group II. VA 4 and 5 type according to Laun, was significantly higher in group II compared with group I (p=0.0324). The occurrence of ventricular tachycardia was recorded in 5.7 % (n=3) of patients in group I and 9.3 % (n=5) patients of group II (p=0.347). In group II, there was a tendency to more episodes of ischemia compared with group I (p=0.072). The duration of ischemia was significantly longer in group I, compared with group II (p=0.042). Conclusions. The results of the study did not show significant differences in the development of the number of episodes of myocardial ischemia according to Holter monitoring depending on the condition of the coronary arteries. The duration of episodes of ischemia in patients with INOCA is significantly longer than in patients with obstructive atherosclerosis. In patients with coronary heart disease with obstructive coronary arteries, ventricular arrhythmia was statistically significantly more severe according to Lown

scholarly journals Impact of ranolazine on exercise tolerance and arrhythmias in patients with INOCA

2021 ◽  
pp. 10-15
Author(s):  
Vira Tseluyko ◽  
Tetyana Pylova
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Arteries ◽  
Exercise Test ◽  
Exercise Tolerance ◽  
Ventricular Arrhythmias ◽  
Ecg Monitoring ◽  
Holter Ecg ◽  
Group I ◽  
Group Ii

The aim of the study to evaluate the effect of supplementation of basic therapy by ranolazine in patients with INOCA on exercise test parameters and Holter ECG monitoring. Materials and methods. 53 patients with stable coronary heart disease were examined, including 18 men (33.9 %) and 35 (66 %) women, the average age of patients was 57 (±9.68) years. According to the results of coronary angiography all patients had non-obstructive coronary arteries. In addition to physical and laboratory examination, bicycle ergometry, Holter ECG monitoring and echocardiography were included in the examination of patients. Patients were divided into 2 groups: group I - patients who in addition to standard therapy received ranolazine at a dose of 1000 mg twice a day for 6 months, and group II patients with standard coronary heart disease therapy. After 6 months from the beginning of the observation an objective examination, echocardiography, exercise test, Holter ECG monitoring were repeated. Results. The study found that patients receiving ranolazine in addition to standard therapy had a statistically significant increase in exercise duration after 6 months compared with baseline and group II. Before treatment in group I, the duration of the exercise test was 356.51±180.24s, and after treatment 414.32±142.10s (p=0.03). In group II, the duration of the test before treatment was 361.4±160.24 c, and after 380.5±152.2 s (p=0.15). It was also found that the duration of the test differed significantly in group I after treatment of patients from group II after treatment of patients with a standard treatment regimen (p=0.04). According to the results of Holter ECG monitoring in group I found a positive effect of ranolazine on the frequency of ventricular arrhythmias: before treatment n=1142 [30; 2012], after treatment n=729 [23; 1420], while in group II a significant difference between the number of extrasystoles before treatment and after not detected (n=1026 [17; 1920], n=985 [15; 1680], respectively) p=0.18. Conclusions. The addition of ranolazine to the basic therapy of patients with non-obstructive coronary arteries disease helps to increase exercise tolerance (according to the loading stress test) and contributes to a significant reduction in the number of ventricular arrhythmias (according to Holter-ECG) compared with both baseline and group II

scholarly journals Effect of Mobile Internet on Attitude and Self-Efficacy of Patients with Coronary Heart Disease Diagnosed by 12-Lead Holter ECG

2022 ◽  
Vol 2022 ◽  
pp. 1-7
Author(s):  
Haitao Sun ◽  
Jing Li ◽  
Yue Wang ◽  
Xiaoke Ma
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Clinical Data ◽  
Self Efficacy ◽  
Mobile Internet ◽  
Control Group ◽  
Study Group ◽  
Holter Ecg ◽  
Group I ◽  
Group Ii

Objective. To explore the effect of mobile Internet on attitude and self-efficacy of patients with coronary heart disease (CHD) diagnosed by 12-lead Holter ECG. Methods. The clinical data of 62 patients with CHD who underwent routine ECG examination (control group I) and 12-lead dynamic electrocardiogram (control group II) in our hospital (June 2017–December 2020) were retrospectively analyzed, and the clinical data of another 62 patients with CHD who received 12-lead Holter ECG examination combined with mobile Internet in our hospital at the same time (study group) were retrospectively analyzed. The clinical observation indexes of the three groups were compared. Results. No obvious difference in general data among groups ( P > 0.05 ). Compared with the control group I, the positive detection rate (PDR) of the study group and the control group II was obviously higher ( P < 0.05 ), and the PDR of the study group was obviously higher than that of the control group II, without remarkable difference between both groups ( P > 0.05 ). Compared with the control group, the scores of CAS-R of the study group were obviously higher ( P < 0.05 ), and self-efficacy of daily life, health behaviors, medication compliance, and compliance behavior of the study group was obviously better ( P < 0.05 ). The diagnostic efficacy was derived by ROC curve analysis, 12-lead Holter ECG combined with mobile Internet + routine ECG > 12-lead Holter ECG combined with mobile Internet > 12-lead Holter ECG > routine ECG. Conclusion. Compared with the routine ECG, the sensitivity of 12-lead Holter ECG in the diagnosis of CHD is conspicuously higher. Meanwhile, 12-lead Holter ECG combined with mobile Internet can enhance the diagnostic efficiency and improve patients’ perceived control attitude and self-efficacy.

scholarly journals Application of bilateral internal mammary artery with different configurations in coronary artery bypass grafting

2020 ◽  
Author(s):  
Zengqiang Han ◽  
Guodong Zhang ◽  
Shenglong Chen ◽  
Gang Liu ◽  
Yu Chen
Keyword(s):  
Blood Flow ◽  
Coronary Artery ◽  
Internal Mammary Artery ◽  
Bypass Graft ◽  
Clinical Results ◽  
Term Survival ◽  
Group I ◽  
Internal Mammary ◽  
Group Ii

Abstract Background: A large number of studies have shown that BIMA grafting is superior to single internal mammary artery grafting in cardiac function protection and long-term survival after surgery. While, there is still no consensus on how is the best configuration to use BIMA. This study aims to compare intraoperative blood flow, early clinical results and early postoperative patency of different configurations of BIMA. Methods: There were 74 patients who underwent CABGs with bilateral internal mammary artery with different configurations we included. According to the different target territories that RIMA grafted to, the patients were divided into bilateral group (group I) with 20 cases and left group (group II) with 54 cases. Intraoperative blood flow, early clinical results and early postoperative patency of different configurations of BIMA were compared. Results: There was no difference in the early postoperative death and major complications between group I and Group II(P༞0.05). Compared with the LIMA in group II, the LIMA in group I had a slightly higher DF value (76.7 ± 6.2 vs 73.1 ± 6.8, P = 0.040). Compared with the RIMA in group II, the RIMA in group I had a slightly higher MGF (51.7 ± 34.4 ml/min vs 31.4 ± 21.4 ml/min, P = 0.024). There was no difference in the other TTFM parameters of LIMA and RIMA between group I and Group II(P༞0.05). Further subgroup analysis revealed that compared with free RIMA in group II, in situ RIMA had a higher DF value(71.4 ± 7.8 vs 61.8 ± 18.1 ,P = 0.025).The PI of LIMA in free RIMA subgroup was higher than the PI of LIMA in in-situ RIMA subgroup(3.0 ± 1.6 vs 2.1 ± 1.0,P = 0.018). The results of early postoperative CTA examination showed that all IMAs grafts were completely patent. Conclusions The use of BIMA for CABG is safe and efficacious, RIMA used in right coronary artery received more satisfactory graft flow. BIMA with no stenosis and occlusion in the early stage, therefore is the ideal and stable coronary bypass graft.

Coronary vasomotor and blood flow responses to isoflavone-intact soya protein in subjects with coronary heart disease or risk factors for coronary heart disease

2008 ◽  
Vol 115 (12) ◽  
pp. 353-359 ◽  
Author(s):  
Carolyn M. Webb ◽  
Christopher S. Hayward ◽  
Mark J. Mason ◽  
Charles D. Ilsley ◽  
Peter Collins
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Blood Flow ◽  
Heart Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Circulation ◽  
Soya Protein ◽  
Short Term ◽  
Luminal Diameter

Results in animals suggest favourable coronary vasomotor actions of isoflavones; however, the effects of isoflavones on the human coronary circulation have not been determined. In the present study, we therefore investigated the effects of short-term isoflavone-intact soya protein ingestion on basal coronary arterial tone and stimulated vasoreactivity and blood flow in patients with CHD (coronary heart disease) or risk factors for CHD. Seventy-one subjects were randomized, double-blind, to isoflavone-intact soya protein [active; n=33, aged 58±8 years (mean±S.D.)] or isoflavone-free placebo (n=38, aged 61±8 years) for 5 days prior to coronary angiography. In 25 of these subjects, stimulated coronary blood flow was calculated from flow velocity, measured using intracoronary Doppler and coronary luminal diameter before and after intracoronary adenosine, ACh (acetylcholine) and ISDN (isosorbide dinitrate) infusions. Basal and stimulated coronary artery luminal diameters were measured using quantitative coronary angiography. Serum concentrations of the isoflavones genistein, daidzein and equol were increased by active treatment (P<0.001, P<0.001 and P=0.03 respectively). Basal mean luminal diameter was not significantly different between groups (active compared with placebo: 2.9±0.7 compared with 2.73±0.44 mm, P=0.31). There was no difference in luminal diameter, flow velocity and volume flow responses to adenosine, ACh or ISDN between groups. Active supplement had no effect on basal coronary artery tone or stimulated coronary vasoreactivity or blood flow compared with placebo. Our results suggest that short-term consumption of isoflavone-intact soya protein is neither harmful nor beneficial to the coronary circulation of humans with CHD or risk factors for CHD. These results are consistent with recent cautions placed on the purported health benefits of plant sterols.

scholarly journals Application of bilateral internal mammary artery with different configurations in coronary artery bypass grafting

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Zengqiang Han ◽  
Guodong Zhang ◽  
Shenglong Chen ◽  
Gang Liu ◽  
Yu Chen
Keyword(s):  
Blood Flow ◽  
Coronary Artery ◽  
Internal Mammary Artery ◽  
Bypass Graft ◽  
Clinical Results ◽  
Term Survival ◽  
Group I ◽  
Internal Mammary ◽  
Group Ii

Abstract Background A large number of studies have shown that BIMA grafting is superior to single internal mammary artery grafting in cardiac function protection and long-term survival after surgery. While, there is still no consensus on how is the best configuration to use BIMA. This study aims to compare intraoperative blood flow, early clinical results and early postoperative patency of different configurations of BIMA. Methods There were 74 patients who underwent CABGs with bilateral internal mammary artery with different configurations we included. According to the different target territories that RIMA grafted to, the patients were divided into bilateral group (group I) with 20 cases and left group (group II) with 54 cases. Intraoperative blood flow, early clinical results and early postoperative patency of different configurations of BIMA were compared. Results There was no difference in the early postoperative death and major complications between group I and Group II(P>0.05). Compared with the LIMA in group II, the LIMA in group I had a slightly higher DF value (76.7 ± 6.2 vs 73.1 ± 6.8, P = 0.040). Compared with the RIMA in group II, the RIMA in group I had a slightly higher MGF (51.7 ± 34.4 ml/min vs 31.4 ± 21.4 ml/min, P = 0.024). There was no difference in the other TTFM parameters of LIMA and RIMA between group I and Group II(P>0.05). Further subgroup analysis revealed that compared with free RIMA in group II, in situ RIMA had a higher DF value (71.4 ± 7.8 vs 61.8 ± 18.1,P = 0.025). The PI of LIMA in free RIMA subgroup was higher than the PI of LIMA in in-situ RIMA subgroup (3.0 ± 1.6 vs 2.1 ± 1.0,P = 0.018). The results of early postoperative CTA examination showed that all IMAs grafts were completely patent. Conclusions The use of BIMA for CABG is safe and efficacious, RIMA used in right coronary artery received more satisfactory graft flow. BIMA with no stenosis and occlusion in the early stage, therefore is the ideal and stable coronary bypass graft.

scholarly journals Long-Term Angiographic Results of Recanalization of Small Diameter Coronary Arteries in Patients with Coronary Heart Disease

2021 ◽  
pp. 10-13
Author(s):  
E. V. Aksenov ◽  
R. B. Demchenko
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Coronary Arteries ◽  
Balloon Angioplasty ◽  
Postoperative Period ◽  
Small Diameter ◽  
Mean Diameter ◽  
History Of

One of the most serious problems of modern times are cardiovascular diseases, and these are the leading cause of death worldwide. The main contribution to the structure thereof belongs to coronary heart disease (CHD) which has become the greatest threat to the health of the population all over the world. The aim. To study the results of endovascular procedures in revascularization of small diameter coronary arteries. Materials and methods. The study included 417 patients aged 59 to 78 years with a mean diameter of the true in-ternal lumen of the arteries of 2.75±0.016 mm who underwent revascularization of the myocardium through stenting or percutaneous transluminal balloon coronary angioplasty (PTCA). In patients undergoing stenting of coronary artery (N=269), the mean diameter of the true internal lumen of the arteries was 2.68±0.03 mm. In the group of patients who underwent PTCA (N=148), this indicator was found to be 2.61±0.09 mm. The average degree of stenosis was 81.3±4.07%. The length of the artery stenosis was 12.4±0.71 mm. All the patients had the history of Q wave myocardial infarction (MI) more than 3 months ago, which made it possible to diagnose postinfarction cardiosclerosis. Ischemic history of more than 5 years was noted in 46 patients of this group (11.03% of cases), up to one year in 221 patients (70.2% of cases), from 1 to 2 years in 41 patients (9.83% cases), and 3 to 4 years in 38 people (9.11% of cases). Results and discussion. As a result of the studies, it was found that in patients with eccentric type of stenosis who used balloon angioplasty, restenosis in the remote postoperative period was 21% more frequent compared to a similar contingent of patients with implanted stents. In addition, restenosis of the stenosed area of the coronary artery > 1.5 mm in the distant period was 14.9% more common when PTCA was performed. And the frequency of remote restenosis (with complex morphology of initial damage of the arteries) in the stenting group was 14.2% lower than in the group of PTCA. Additionally, in the group of patients who underwent stenting, neoatherosclerosis in the treated segment was found in 92 patients (34.2 %). Patients with PTCA had a less progress of atherosclerosis (44 patients 29.72%) Conclusions. Restenosis in the remote postoperative period was 25.4 % less frequent in patients with eccentric ste-nosis who underwent stenting than in patients with balloon angioplasty. At the same time, restenosis of the stenosed area of CA >15 mm in the distant period was 10.43% more frequent during PTCA. In the coronary angioplasty group, patients with complicated morphology of basal damage of arteries had a 21.67% higher incidence of restenosis than in the coro-nary stenting group. Thus, we plan to carry out further study and analysis of immediate and long-term results of X-ray and endovascular operations in patients with coronary artery disease and small coronary artery diameter.

scholarly journals Application of bilateral internal mammary artery with different configurations in coronary artery bypass grafting

2020 ◽  
Author(s):  
Zengqiang Han ◽  
Guodong Zhang ◽  
Shenglong Chen ◽  
Gang Liu ◽  
Yu Chen
Keyword(s):  
Blood Flow ◽  
Coronary Artery ◽  
Internal Mammary Artery ◽  
Bypass Graft ◽  
Clinical Results ◽  
Term Survival ◽  
Group I ◽  
Internal Mammary ◽  
Group Ii

Abstract Background: A large number of studies have shown that BIMA grafting is superior to single internal mammary artery grafting in cardiac function protection and long-term survival after surgery. While, there is still no consensus on how is the best configuration to use BIMA. This study aims to compare intraoperative blood flow, early clinical results and early postoperative patency of different configurations of BIMA.Methods:There were 74 patients who underwent CABGs with bilateral internal mammary artery with different configurations we included. According to the different target territories that RIMA grafted to, the patients were divided into bilateral group (group I) with 20 cases and left group (group II) with 54 cases. Intraoperative blood flow, early clinical results and early postoperative patency of different configurations of BIMA were compared.Results: There was no difference in the early postoperative death and major complications between group I and Group II(P＞0.05). Compared with the LIMA in group II, the LIMA in group I had a slightly higher DF value (76.7±6.2 vs 73.1±6.8, P=0.040). Compared with the RIMA in group II, the RIMA in group I had a slightly higher MGF (51.7±34.4ml/min vs 31.4±21.4ml/min, P=0.024). There was no difference in the other TTFM parameters of LIMA and RIMA between group I and Group II(P＞0.05). Further subgroup analysis revealed that compared with free RIMA in group II, in situ RIMA had a higher DF value(71.4±7.8 vs 61.8±18.1 ,P=0.025).The PI of LIMA in free RIMA subgroup was higher than the PI of LIMA in in-situ RIMA subgroup(3.0±1.6 vs 2.1±1.0,P=0.018). The results of early postoperative CTA examination showed that all IMAs grafts were completely patent.ConclusionsThe use of BIMA for CABG is safe and efficacious, RIMA used in right coronary artery received more satisfactory graft flow. BIMA with no stenosis and occlusion in the early stage, therefore is the ideal and stable coronary bypass graft.

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