title: Significance of graft occlusion and coronary atherosclerosis 5 years after coronary artery bypass grafting. A quantitative angiographic study with serial exercise testing.
abstract: OBJECTIVE
  To evaluate the relative importance of graft occlusions and progression of atherosclerosis in coronary arteries as causes of the occurrence of angina pectoris and impairment of physical performance 5 years after coronary artery bypass surgery.
  
  
  METHODS
  A 5-year follow-up study.
  
  
  METHODS
  University hospital in south-western Finland.
  
  
  METHODS
  Altogether, 174 consecutive electively operated bypass patients.
  
  
  METHODS
  Serial clinical evaluation and bicycle exercise tests (pre-operatively, at 6 months, and at 1 and 5 years). Quantitative coronary angiography pre-operatively and 5 years after the surgery.
  
  
  RESULTS
  Subjects with patent grafts had fewer angina pectoris symptoms at the 5-year follow-up (24 vs. 52%, P = 0.001) and were treated less frequently with long-acting nitrates (3 vs. 15%, P = 0.037) than subjects with graft occlusions. Fewer of them were in classes II-III of the functional classification of the Canadian Cardiovascular Society (39 vs. 74%, P = 0.001). The exercise test was interrupted less often because of chest pain (23 vs. 41%, P = 0.03) and improvement in exercise test variables during the follow-up period was significantly greater in subjects with patent grafts (P<0.002). Amongst patients without graft occlusions, those with new > or =50% diameter stenoses in coronary arteries were more often in functional classes II-III (59 vs. 32%, P = 0.03) than those without new stenoses, but the groups were similar with respect to angina pectoris and exercise tests variables. In patients with graft occlusions, those with and without new > or =50% diameter stenoses were similar with respect to functional class, angina pectoris and exercise test variables.
  
  
  CONCLUSIONS
  Angina pectoris and impairment of physical capacity 5 years after coronary artery bypass grafting are mainly due to occlusion of bypass grafts and not to progression of atherosclerosis in coronary arteries.
authors.affiliation: Department of Medicine, Central Hospital of Vaasa, Finland.
authors.forename: K
authors.initials: K
authors.lastname: Korpilahti
authors.forename: E
authors.initials: E
authors.lastname: Engblom
authors.forename: H
authors.initials: H
authors.lastname: Hämäläinen
authors.forename: M
authors.initials: M
authors.lastname: Syvänne
authors.forename: E
authors.initials: E
authors.lastname: Hietanen
authors.forename: M
authors.initials: M
authors.lastname: Arstila
authors.forename: P
authors.initials: P
authors.lastname: Puukka
authors.forename: T
authors.initials: T
authors.lastname: Rönnemaa
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D003327:Coronary Disease / Q000000981:diagnostic imaging; D018450:Disease Progression; D005080:Exercise Test; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged