Recurrence of angin after coronary artery bypass surgery: Predictors and prognosis (CASS registry)

Objectives. This study sought to define the predictors and prognosis of postoperative angin in patients undergoing coronary artery bypass surgery. Background. Angin recurs in the first postoperative year in 20% to 30% of patients after coronary artery bypass surgery. The Coronary Artery Surgery Study Registry provides an opportunity to study the predictors and prognosis of postoperative angin in large sample. Methods. All patients with isolated coronary artery bypass surgery in the registry were identified, and anginal status was determined on yearly basis. The influence of angin on mortality, recurrent myocardial infarction and need for reoperation was determined. Results. Angin recurred in the first year in 24% of patients and by the sixth year in 40%. The significant predictors in multivariate analysis were minimal coronary artery disease, preoperative angina, use of vein grafts only, previous myocardial infarction, incomplete revascularization, female gender, smoking and younger age. In subsequent years important predictors were angin in the first postoperative year, female gender, younger age and incomplete revascularization. The presence of angin in the first postoperative year was associated with more frequent myocardial infarction (p = 0.04) and greater need for reoperation (p = 0.003) but did not affect survival during the 6-year follow-up period. Conclusions. These findings show that the predictors of postoperative angin are features that are or could be predicted before bypass surgery. Thus, patients with these features before bypass surgery could be advised that they would be more likely to experience postoperative angin than those without these features. Postoperative angin is associated with an increased risk of late myocardial infarction and reoperation.