An unusual case of sudden occlusion of a saphenous vein bypass graft to the right coronary artery, during a coronary angiographic study, is presented. Such occlusion was relieved by direct intragraft nitroglycerin injection, as typically happens in case of coronary arterial spasm. A possible pathogenetic mechanism, based on the present knowledge of platelet aggregation and the role of the powerful vasoactive agent Thromboxane A2, is discussed.

Prognosis during 4.5 years of follow-up after myocardial infarction (MI) in 2 groups of patients 25 to 65 years of age was related to physical rehabilitation and usual risk factors. We randomized 167 patients to a rehabilitation (R) group and a control (C) group (84 and 83 patients respectively). At the end of the training period, the R group had a significantly higher work capacity, a higher double product reached during the stress test and lower triglycerides. During the 55 months of follow-up after the physical training or the equivalent spontaneous activity, we observed the prevalence of risk factors and of cardiac events such as angina, new MI, unstable angina, coronary bypass grafting and cardiac death. Survival rate was 92.6% in the R group and 93.7% in the C group. There was no relationship between serum cholesterol levels, tobacco smoking, and blood pressure and mortality and morbidity after the infarction. R patients were more symptom-free (44% against 30%), and had almost the same number of episodes of unstable angina and of cardiac death. 6.1% of the R group and 11.2% of the C group developed a new myocardial infarction. As in previous randomized studies we did not reach statistical significance for long-term benefit, perhaps because of the low sample size. However, our study confirmed a favorable tendency in terms of symptoms and the self confidence of the R patients.

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