title: Late survival and predictors of recurrent angina after coronary artery reoperation.
abstract: Although coronary artery reoperations are now well established, there is limited information concerning factors predisposing to further recurrent angina after a successful second bypass operation. We have retrospectively evaluated the late (10-year) results, and identified predictors associated with poor long-term outcome, of fifty-seven consecutive patients, mean age 54.8 (SD = 9.7) years, range 43 to 67 years, reoperated on for recurrent angina (RA) between January 1980 and May 1988. Twenty-four factors possibly influencing the probability of further recurrence of angina (FRA) were evaluated, comparing operative survivors who developed FRA with those who remained symptom-free during a complete follow-up study period ranging from 35 to 134 months. Reoperative mortality was 8.7% [95% confidence limits (95% CL) 6.7 to 11%]. Survival analysis (Kaplan-Meier) revealed 94% at 3 (95% CL +/- 7%), 90% at 5 (95% CL +/- 8%) and 83% at 10 years (95% CL +/- 12%). Probability of freedom from FRA was 88%, 73%, and 56% at 1, 5, and 10 years, respectively. Using univariate analysis, female sex (p < 0.05), time between 1st operation and RA (p < 0.005), family history of ischaemic heart disease (IHD) (p < 0.01), obesity (p < 0.001), time between 1st and 2nd operation (p < 0.001), and the non-use of internal mammary artery at reoperation (p < 0.0001) were associated with increased incidence of FRA. Independent risk-factors, by multivariate analysis (Cox's proportional hazards), were: family history of IHD (p = 0.006), triple-vessel disease (p = 0.024), obesity (p = 0.052), and time interval-between 1st and 2nd operation (p = 0.046). We conclude that reoperative surgery results in satisfactory long-term survival and angina-free interval. Patients with a short time interval between reoperations, family history of IHD, obesity, triple-vessel disease, and non-use of internal mammary artery at reoperation are at higher risk of developing further recurrent angina, and, therefore, more likely to require a subsequent revascularisation procedure.
authors.affiliation: Regional Cardiothoracic Center, Freeman Hospital, Newcastle-upon-Tyne, U.K.
authors.forename: D
authors.initials: D
authors.lastname: Dougenis
authors.forename: P J
authors.initials: PJ
authors.lastname: Kelly
authors.forename: A H
authors.initials: AH
authors.lastname: Brown
mesh_terms: D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000601:surgery*; D015984:Causality; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome