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Late recurrent angina pectoris after coronary artery bypass graft surgery

Sary Aranki, MD
Rakesh M Suri, MD, DPhil
John A Bittl, MD
Section Editors
Donald Cutlip, MD
Stephan Windecker, MD
Deputy Editor
Gordon M Saperia, MD, FACC


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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Literature review current through: Nov 2017. | This topic last updated: Oct 19, 2017.
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