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(mean, 10 days). Aspirin plus dipyridamole significantly (p=0.017) reduced the occlusion rate of distal anastomoses from 18% (placebo) to 12.9%. Occlusion rate in the aspirin group was 14%, which approached statistical significance (p=0.058). Furthermore, only aspirin plus dipyridamole reduced (p=0.01) the number of patients with occluded grafts (placebo, 33%; aspirin, 27.1%; aspirin plus dipyridamole, 24.3%). Mediastinal drainage was slightly higher (p=0.04) in the aspirin plus dipyridamole group (713±456 ml) than in the other two groups (placebo, 670±437 ml; aspirin, 629±337 ml), but hospital mortality (average, 4.6%) and early reoperation (average, 3.9o) rates were similar among the three groups. Thus, low-dose aspirin plus dipyridamole safely improves early saphenous vein aortocoronary graft patency; this effect is an added benefit to a preoperative regimen of dipyridamole. (Circulation 1990;82:765-773) T he results of several controlled trials have demonstrated that platelet-inhibiting drugs may prevent early aortocoronary vein graft occlusion"2; however, some questions such as the optimal combination and doses of antiaggregant agents remain undetermined.3 Because large doses of aspirin prevent the production of thromboxane A2 but also inhibit the formation of the wall vessel antiaggregant prostacyclin, it has been suggested that a lower dose of aspirin may improve both clinical efficacy and tolerance.45 However, the clinical benefit of such low doses on graft patency has not yet been proved in a large-scale clinical trial.

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The effectiveness and duration of the anti-anginal action of two sustained-release preparations, molsidomine (8 mg) and isosorbide dinitrate (20 mg), were assessed by means of serial exercise tests in 12 patients with angina of effort. The tests, which were limited by the symptoms, were carried out on three consecutive days using the Bruce protocol. Each patient was tested four times each day: the first test was performed before treatment and the others were carried out 1, 4 and 8 h after administration of the drug or placebo. One hour after administration of molsidomine, the appearance of signs of ischaemia in the ECG were considerably delayed and they were reduced in magnitude. Furthermore, the length of time during which the patients were free of angina increased. After 4 h both drugs significantly delayed the onset of angina and depression of the ST segment by 1 mm. The conclusion is that at the doses used both drugs prolong the length of time in which there is no angina, but that they have no significant effect at 8 h.

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