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Significance of graft occlusion and coronary atherosclerosis 5 years after coronary artery bypass grafting. A quantitative angiographic study with serial exercise testing.

AbstractOBJECTIVE:
To evaluate the relative importance of graft occlusions and progression of atherosclerosis in coronary arteries as causes of the occurrence of angina pectoris and impairment of physical performance 5 years after coronary artery bypass surgery.
DESIGN:
A 5-year follow-up study.
SETTING:
University hospital in south-western Finland.
SUBJECTS:
Altogether, 174 consecutive electively operated bypass patients.
MAIN OUTCOME MEASURES:
Serial clinical evaluation and bicycle exercise tests (pre-operatively, at 6 months, and at 1 and 5 years). Quantitative coronary angiography pre-operatively and 5 years after the surgery.
RESULTS:
Subjects with patent grafts had fewer angina pectoris symptoms at the 5-year follow-up (24 vs. 52%, P = 0.001) and were treated less frequently with long-acting nitrates (3 vs. 15%, P = 0.037) than subjects with graft occlusions. Fewer of them were in classes II-III of the functional classification of the Canadian Cardiovascular Society (39 vs. 74%, P = 0.001). The exercise test was interrupted less often because of chest pain (23 vs. 41%, P = 0.03) and improvement in exercise test variables during the follow-up period was significantly greater in subjects with patent grafts (P<0.002). Amongst patients without graft occlusions, those with new > or =50% diameter stenoses in coronary arteries were more often in functional classes II-III (59 vs. 32%, P = 0.03) than those without new stenoses, but the groups were similar with respect to angina pectoris and exercise tests variables. In patients with graft occlusions, those with and without new > or =50% diameter stenoses were similar with respect to functional class, angina pectoris and exercise test variables.
CONCLUSIONS:
Angina pectoris and impairment of physical capacity 5 years after coronary artery bypass grafting are mainly due to occlusion of bypass grafts and not to progression of atherosclerosis in coronary arteries.
AuthorsK Korpilahti, E Engblom, H Hämäläinen, M Syvänne, E Hietanen, M Arstila, P Puukka, T Rönnemaa
JournalJournal of internal medicine (J Intern Med) Vol. 245 Issue 5 Pg. 545-52 (May 1999) ISSN: 0954-6820 [Print] ENGLAND
PMID10363756 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
Topics
  • Aged
  • Coronary Angiography
  • Coronary Artery Bypass
  • Coronary Artery Disease (radiography)
  • Coronary Disease (radiography)
  • Disease Progression
  • Exercise Test
  • Female
  • Finland
  • Follow-Up Studies
  • Graft Occlusion, Vascular (radiography)
  • Humans
  • Male
  • Middle Aged

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