Coronary bypass for acute rest angina. 10 year follow-up.

Abstract

SUMMARY We followed up for 6*5 to 10*3 years 100 consecutive patients who had had coronary bypasses (1.8 per person) for acute angina at rest. There was a mean of 2*1 coronary stenoses per person. Mortality rates were 1-4% per postoperative year, or 2*2 times that of normal subjects of the same age. Angina was usually satisfactorily relieved but severe recurrences, mainly from late graft closure, required reoperation in 20 patients. Life style has been preserved; and 91 resumed work, with 52 at an average age of 61 years continuing to work eight years later. Better results than these may be obtained from the improved diagnostic and therapeutic methods of the 1980's.Early reports of bypass surgery for acute coronary insufficiency indicated that a pronounced relief of angina could be obtained at a mean cost of 80/o hospital mortality.' 6 The subsequent course up to 10 years after such operations has been described in a single report. The survivors had a relatively low mean yearly mortality of 3%, the prevalence of angina rose from 190/o at one year after operation to 53% at five years, and those patients with better treadmill tolerance had significantly fewer acute coronary events.7Our first 100 patients undergoing urgent bypass had a total operative mortality of 0-8%, comparable to that of many centres today. We present their followup course to 10 years. We found that 89% of patients were alive and 84% of them had class I or II effort tolerance a mean of 7.8 years after operation; this supports the growing view that revascularisation of unstable anginal states can have enduring benefits at acceptable costs. The palliative nature of the procedure was shown by the fact that 20 patients required a second operation an average of 3 years after the first.