Medical and Surgical Treatment of Recurrent Angina After Coronary Artery Bypass Surgery

Abstract

The ability of various clinical and invasive variables to predict prognosis in symptomatic patients undergoing coronary angiography after coronary artery bypass graft (CABG) surgery are compared. Of 163 symptomatic patients restudied after initial CABG surgery, 139 (85%) were treated medically and 24 (15%) were treated with repeat CABG surgery. Compared with the medically treated group, the surgically treated group had more severe segmental wall-motion abnormalities, but coronary occlusions of less severe extent. Follow-up data were available on all 163 patients for up to four years after their post-CABG surgery catheterization. There were 20 deaths, 18 in the medical group and two in the surgical group. Survival curves revealed a four-year survival rate of 71 % for medically treated patients and of 92 % for surgically treated patients (P = NS). The coronary artery disease (CAD) score, which reflects the location and severity of coronary occlusions and left ventricular ejection fraction (LVEF), were the most important prognostic factors, as determined by Cox model analysis. It is noteworthy that 64 % of surviving patients, but only 40 % of nonsurvivors, had three or more grafts implanted at the initial CABG surgery, which suggests that completeness of revascularization is an important factor. Thus, repeat CABG surgery may be performed safely with low risk and with excellent long-term results in a selected group of patients. As in patients with general CAD, left ventricular function [LVEF] and extent of CAD (assessed by CAD score) are also the major prognostic factors in survival of patients who developed symptoms after CABG surgery.