Diagnostic and Management Strategies in Patients with Late Recurrent Angina after Coronary Artery Bypass Grafting

Abstract

Purpose of Review This review will outline the current evidence on the anatomical, functional, and physiological tools that may be applied in the evaluation of patients with late recurrent angina after coronary artery bypass grafting (CABG). Furthermore, we discuss management strategies and propose an algorithm to guide decision-making for this complex patient population. Recent Findings Patients with prior CABG often present with late recurrent angina as a result of bypass graft failure and progression of native coronary artery disease (CAD). These patients are generally older, have a higher prevalence of comorbidities, and more complex atherosclerotic lesion morphology compared to CABG-naïve patients. In addition, guideline recommendations are based on studies in which post-CABG patients have been largely excluded. Summary Several invasive and non-invasive diagnostic tools are currently available to assess graft patency, the hemodynamic significance of native CAD progression, left ventricular function, and myocardial viability. Such tools, in particular the latest generation coronary computed tomography angiography, are part of a systematic diagnostic work-up to guide optimal repeat revascularization strategy in patients presenting with late recurrent angina after CABG.

Long-Term Outcomes after Coronary Artery Bypass Grafting with Risk Stratification

“…It is well established that the long-term efficacy of CABG is hindered by bypass graft failure and the progression of the original coronary artery disease, resulting in late recurrent angina. There was an 18% incidence of recurrent angina symptoms and ischemia at 5 years after CABG, which increased to 40% -50% at 10 years and up to 60% at 15 years following the operation [21].…”

“…Many patients who underwent CABG go through repeated cardiac catheterization and necessitate consequent revascularization therapy [24] [25]. It is essential to note that the distinction between recurrent chest pain due to angina from other causes of chest pain requires investigations and imaging studies of the heart [21].…”

Prevention of neointimal hyperplasia after coronary artery bypass graft via local delivery of sirolimus and rosuvastatin: network pharmacology and in vivo validation

“…Vascular trauma, when coupled with in ammation, thrombosis, or cell proliferation, can cause neointimal hyperplasia (NIH) of graft and anastomotic sites and consequent partial or total lumen obstruction. These pathophysiological processes can lead to both early and late graft failure after surgery [5,7,8]. NIH of graft and anastomotic sites, which represents a key contributor to graft failure, is a complex process that occurs sequentially in three stages.…”