Clinical study
Comparison of internal mammary artery ligation and sham operation for angina pectoris

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Abstract

A sham operation was compared to ligation of the internal mammary arteries in patients with angina pectoris. Patient improvement was identical. The exercise electrocardiogram was not altered by either procedure.

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Cited by (255)

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    In 1939, Davide Fieschi was the first to ligate the RIMA, a procedure which was subsequently modified to bilateral IMA (BIMA) ligation with initial reports of nearly universal efficacy for relief of angina (9). However, early enthusiasm was dampened by 2 randomized trials that demonstrated no difference in symptomatic improvement among patients undergoing BIMA ligation versus those who underwent sham procedures (10,11). In 1946, Arthur Vineberg performed his eponymously named procedure in which the LIMA was “transplanted” into the anterior wall of the left ventricle, adjacent to the left anterior descending artery (LAD) but without creating a surgical anastomosis (12).

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    Creating a placebo control for an open surgery is much more challenging as it would require a large skin incision and this is one of the reasons why, after the internal mammary artery ligation trials in the 1950s and 1960s, open surgery trials with placebo control have not been attempted.104 The first surgical placebo-controlled trials were performed by Cobb and colleagues (1959)108 and by Dimond and colleagues (1960)109 to test the efficacy of the internal mammary artery ligation on symptoms of coronary heart disease. In these studies, some patients had a placebo procedure, that is, a skin incision, instead of the surgical procedure changing vasculature to provide additional blood supply to the coronary vessels.

  • Biostatistics Manual for Health Research: A Practical Guide to Data Analysis

    2023, Biostatistics Manual for Health Research: a Practical Guide to Data Analysis
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This study was aided in part by grants from the Kansas Heart Association and the National Heart Institute (HTS-5210 [C1]).

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