Late survival and predictors of recurrent angina after coronary artery reoperation

Although coronary artery reoperations are now well established, there is limited information concerning factors predisposing to further recurrent angina after a successful second bypass operation. We have retrospectively evaluated the late (10-year) results, and identified predictors associated with poor long-term outcome, of fifty-seven consecutive patients, mean age 54.8 (SD = 9.7) years, range 43 to 67 years, reoperated on for recurrent angina (RA) between January 1980 and May 1988. Twenty-four factors possibly influencing the probability of further recurrence of angina (FRA) were evaluated, comparing operative survivors who developed FRA with those who remained symptom-free during a complete follow-up study period ranging from 35 to 134 months. Reoperative mortality was 8.7% [95% confidence limits (95% CL) 6.7 to 11%]. Survival analysis (Kaplan-Meier) revealed 94% at 3 (95% CL +/- 7%), 90% at 5 (95% CL +/- 8%) and 83% at 10 years (95% CL +/- 12%). Probability of freedom from FRA was 88%, 73%, and 56% at 1, 5, and 10 years, respectively. Using univariate analysis, female sex (p < 0.05), time between 1(st) operation and RA (p < 0.005), family history of ischaemic heart disease (IHD) (p < 0.01), obesity (p < 0.001), time between 1(st) and 2(nd) operation (p < 0.001), and the non-use of internal mammary artery at reoperation (p < 0.0001) were associated with increased incidence of FRA. Independent risk-factors, by multivariate analysis (Cox's proportional hazards), were: family history of IHD (p = 0.006), triple-vessel disease (p = 0.024), obesity (p = 0.052), and time interval-between 1(st) and 2(nd) operation (p = 0.046). We conclude that reoperative surgery results in satisfactory long-term survival and angina-free interval. Patients with a short time interval between reoperations, family history of IHD, obesity, triple-vessel disease, and non-use of internal mammary artery at reoperation are at higher risk of developing further recurrent angina, and, therefore, more likely to require a subsequent revascularisation procedure.