Six-year clinical and angiographic follow-up of patients with previously documented complete revascularization.

Relatively little information is available concerning the late clinical and angiographic status of patients with initially successful coronary bypass surgery. From 72 patients who had angiography 1 year after bypass surgery, we restudied at 6 years 19 patients with complete revascularization. At 1 year, 14 patients were asymptomatic and five had minimal anginal symptoms. Five years later, eight patients had redeveloped angina, and 11 retained their initial postoperative status. Overall graft patency at 6 years was 86%; 52% of the patients had atherosclerotic progression to > or = 70% luminal narrowing in a major unbypassed vessel or in a major vessel distal to bypass. The patients with unchanged symptoms all had patent grafts, while 11 of the 15 (73%) grafts were patent in patients with symptomatic deterioration (NS). However, progression of coronary disease occurred in seven of eight patients (88%) with worsened symptoms, as opposed to three of 11 patients with unchanged symptoms (P < 0.05). We conclude that late symptomatic deterioration following coronary bypass surgery is common, and that it usually reflects progression of coronary artery disease.