Clinical and angiographic prediction of myocardial infarction and recurrence of severe angina during a five-year follow-up after coronary artery bypass grafting.
In a prospective, angiographically controlled study, 339 consecutive patients were examined to evaluate the pre-, peri- and postoperative risk factors for occurrence of myocardial infarction, and recurrence of severe angina during 5 years after coronary artery bypass grafting (CABG). The incidence of myocardial infarction was 6% and the recurrence of severe angina 13%. No pre- or perioperative variable could predict the occurrence of myocardial infarction. Postoperative ejection fraction was significantly lower in patients with than without myocardial infarction (58 +/- 10% vs 50 +/- 11%; p < 0.001), and the Cox proportional-hazards method showed a low postoperative ejection fraction to be the only significant risk factor for the occurrence of myocardial infarction (p = 0.02). Patients with a recurrence of severe angina had higher blood total cholesterol concentrations (7.7 +/- 1.4 vs 7.0 +/- 1.3 mmol/liter; p < 0.05) and triglyceride levels (2.7 mmol/l +/- 1.5 vs 2.0 +/- 1.0 mmol/liter; p < 0.01) than did those without angina, and also more often had > or = 1 occluded bypass graft 3 months after CABG (p < 0.05). No other pre- or postoperative variable could predict the recurrence of angina. Both total blood cholesterol concentration and triglyceride level were significant predictors of the risk of recurrent severe angina by the Cox proportional-hazards method (p = 0.01 and 0.03, respectively). Thus, reduced ejection fraction is a risk factor for subsequent myocardial infarction, whereas blood lipid abnormalities predict the recurrence of severe angina during the 5 years after CABG.(ABSTRACT TRUNCATED AT 250 WORDS)
Yli-Mäyry
S
S
Department of Medicine, Oulu University Central Hospital, Finland.
Huikuri
H V
HV
D000328:Adult; D000787:Angina Pectoris / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D015994:Incidence; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D010808:Physical Examination; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D013223:Statistics as Topic
D008055:Lipids