Late recurrent angina pectoris after coronary artery bypass graft surgery
- Sary Aranki, MD
Sary Aranki, MD
- Associate Professor of Surgery
- Harvard Medical School
- Rakesh M Suri, MD, DPhil
Rakesh M Suri, MD, DPhil
- Professor of Surgery
- Cleveland Clinic
- John A Bittl, MD
John A Bittl, MD
- Munroe Heart and Vascular Institute
- Munroe Regional Medical Center
- Section Editors
- Donald Cutlip, MD
Donald Cutlip, MD
- Section Editor — Interventional Cardiology
- Professor of Medicine
- Harvard Medical School
- Beth Israel Deaconess Medical Center
- Stephan Windecker, MD
Stephan Windecker, MD
- Section Editor — Coronary Heart Disease
- Professor of Medicine
- Department of Cardiology
- Bern University Hospital
Coronary artery bypass graft surgery (CABG) is performed in patients with stable angina and acute coronary syndromes to prolong life or to treat angina refractory to medical or percutaneous revascularization therapies.
Angina may return after apparently successful CABG. The cause varies with the time when symptoms are first noted after surgery:
●Recurrent angina during the early postoperative period is usually due to a technical problem with a graft or with early graft closure. This is indication for prompt coronary angiography with percutaneous coronary intervention (PCI), if feasible.
●Recurrent angina after the first few months, called late recurrent angina, can occur with the development of stenosis in a bypass graft (either saphenous vein or arterial) or with progression of atherosclerosis in non-bypassed vessels.
This topic will review the management of patients with late recurrent angina after CABG. Early ischemia due to graft occlusion, the technical aspects of percutaneous coronary intervention to treat saphenous vein graft stenosis, and determinants of long-term outcome after CABG are discussed separately. (See "Early noncardiac complications of coronary artery bypass graft surgery" and "Coronary artery bypass graft surgery: Prevention and management of vein graft stenosis" and "Coronary artery bypass graft surgery: Causes and rates of graft failure".)
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- INCIDENCE AND VESSEL INVOLVED
- RISK FACTORS
- CLINICAL MANIFESTATIONS
- Indications for revascularization
- Repeat PCI versus CABG
- Repeat CABG
- Unstable patients
- Chronically occluded saphenous vein grafts
- Post CABG angina in patients with diabetes
- Recommendations of others
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS