Developing a rational management strategy for angina pectoris after coronary bypass surgery: a clinical decision...

Long-term follow-up of patients undergoing coronary artery bypass graft surgery indicates that as many as 50% eventually experience recurrent angina pectoris. Rational management of these individuals requires an understanding of the natural history of coronary bypass grafts, the risks and benefits of both reoperation and angioplasty, as well as a structure within which to integrate these data. This report reviews the literature and employs formal decision analysis to develop a strategy for management of recurrent angina. Our analysis supports the strategy that patients experiencing recurrent angina within 3 years after surgery should undergo prompt angiographic re-evaluation and angioplasty if anatomically suitable. Symptoms beginning more than 6 years after surgery should be managed medically, reserving surgery for refractory symptoms.