Results of Coronary Bypass: A Long-Term Perspective

Abstract

The coronary bypass procedure has gained widespread acceptance as a highly effective form of treatment for angina pectoris. There is also evidence that it prolongs life in patients with three vessel or left main coronary stenosis. We have been particularly interested in the late results of coronary bypass in regard to relief of symptoms and prolongation of life and have therefore determined the fate of 1578 consecutive patients after coronary bypass with followup beyond 5 years in all cases. An initial study was made of clinical, treadmill and angiographic results in 434 patients operated upon between 1968 and 1971. (Lawrie et al. 1977). All patients were followed up for more than 60 months after operation (mean 70.7 months). Of the initial 434 patients, 98 died 0 to 74 (mean 31.1 months) post-oper-atively. Of the 336 survivors, 152 reentered the hospital and underwent standardized clinical assessment. Angina was lessened in 93.4 percent (255 of 273) and absent in 51.3 percent (140 of 273) of these patients. Of patients under 65 years of age, 79.2 percent (152 of 192) were still working. Treadmill exercise tests performed in 107 patients showed an ischemic response in 44.9 percent (48 of 107) and an indeterminate response in 9.3 percent (10 of 107). The duration of the exercise, maximal pulse rate and double product all correlated well with the completeness of revasculariza-tion.