title: Predictors for recurrent chest pain and relationship to myocardial ischaemia during long-term follow-up after coronary artery bypass grafting.
abstract: OBJECTIVE
  To describe the impact of coronary artery bypass grafting on chest pain during 2 years of follow-up after the operation and to identify predictors of chest pain and its relationship to myocardial ischaemia 2 years after the operation.
  
  
  METHODS
  Patients were approached with a questionnaire at the time of coronary angiography (1291) and 3 months (1664), 1 year (1638) and 2 years (1613) after coronary artery bypass grafting. Two years after the operation, a computerised 12-lead electrocardiogram was obtained during a standardised bicycle exercise test (618).
  
  
  RESULTS
  Prior to surgery, 37% of the patients were unable to perform physical activity compared with 6% after the operation (P < 0.0001 for change in degree of limitation). Only 3% had no chest pain at all prior to the operation, while 58% of the patients were free from chest pain 2 years after surgery (P < 0.0001). We found no correlation between patients reporting chest pain and signs of ischaemia at exercise test, but there was a highly significant correlation with chest pain during the exercise test (P < 0.0001). Independent predictors of chest pain were severity of preoperative angina (P < 0.0001), younger age (P = 0.0009), previous coronary artery bypass grafting (P = 0.003), duration of symptoms (P = 0.005), the need for prolonged cardiopulmonary bypass (P = 0.04) and the absence of left main stenosis (P = 0.04).
  
  
  CONCLUSIONS
  Independent predictors of chest pain were identified 2 years after coronary artery bypass grafting. There was a dramatic improvement after coronary artery bypass grafting. However, almost half the patients complained of some kind of chest pain even after the operation. This chest pain correlated well with chest pain during the exercise test but not with signs of myocardial ischaemia.
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Sahlgrenska University Hospital, Göteborg, Sweden.
authors.forename: G
authors.initials: G
authors.lastname: Brandrup-Wognsen
authors.forename: H
authors.initials: H
authors.lastname: Berggren
authors.forename: K
authors.initials: K
authors.lastname: Caidahl
authors.forename: T
authors.initials: T
authors.lastname: Karlsson
authors.forename: H
authors.initials: H
authors.lastname: Sjöland
authors.forename: J
authors.initials: J
authors.lastname: Herlitz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000453:epidemiology / Q000209:etiology*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D010147:Pain Measurement; D011237:Predictive Value of Tests; D011788:Quality of Life; D012008:Recurrence; D012016:Reference Values; D012307:Risk Factors; D011795:Surveys and Questionnaires