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Aorta-coronary bypass in patients with coronary artery disease who do not have angina
Insights
Coronary bypass surgery is safe and effective for patients without angina, showing similar outcomes to those with cardiac pain. This study found comparable long-term results and mortality rates in surgically treated patients regardless of pre-operative symptoms.
Area of Science:
- Cardiology
- Cardiac Surgery
- Vascular Surgery
Background:
- Coronary artery disease (CAD) management often involves surgical intervention for symptomatic patients.
- The role of coronary artery bypass grafting (CABG) in asymptomatic individuals with significant coronary stenosis is less defined.
- Evaluating outcomes in asymptomatic patients is crucial for refining surgical indications.
Purpose of the Study:
- To assess the safety and efficacy of CABG in patients without angina.
- To compare outcomes of CABG in asymptomatic patients versus those with angina.
- To determine if pre-operative absence of angina impacts surgical results.
Main Methods:
- Retrospective analysis of 118 consecutive patients undergoing CABG without angina.
- Comparison with 605 consecutive patients undergoing CABG with angina during the same 8-year period.
- Evaluation of perioperative and late mortality, reoperation rates, and graft patency.
Main Results:
- No operative deaths in the no-angina group; 6.8% late mortality versus 0.83% perioperative and 6.9% late mortality in the angina group.
- No significant differences in age, disease severity, mortality, or graft patency between groups.
- No-angina patients had more prior myocardial infarcts and abnormal ventriculograms; angina group had higher reoperation rates.
Conclusions:
- CABG is a safe and effective treatment option for carefully selected patients without angina.
- Outcomes for surgically treated asymptomatic patients are comparable to those with angina.
- The absence of angina does not appear to be a contraindication for CABG when significant coronary disease is present.
Abstract:
During an 8 year period we performed coronary bypass operations in 118 consecutive patients who were not experiencing angina when selected for surgical treatment. Their mean age was 45 years, collectively they had had 87 myocardial infarcts, and 42% had at least moderately abnormal ventriculograms. Considering 50% coronary stenosis "significant," 9% had single-, 23% double-, and 68% triple-vessel disease; 15% had left main coronary artery disease also. Operations, which involved placing a mean of 3.6 grafts per patient, included 39 endarterectomies and 11 ventricular aneurysm repairs. There were no operative deaths, but eight (6.8%) died during a mean 6.7 year follow-up. A retrospective comparison was made between these 118 patients and a consecutive series of 605 others, mean age 46 years, having angina and also treated surgically during the same period. Five (0.83%) of these latter patients died perioperatively and 42 (6.9%) during a mean follow-up of 6.4 years. The no-angina patients had significantly more prior myocardial infarcts and more abnormal ventriculograms; the angina group had a significantly higher reoperation rate. However, there were no significant differences between the two groups in age, coronary disease severity, results of treadmill testing, number of grafted vessels, endarterectomies, ventricular aneurysm repairs, perioperative infarcts, operative or late mortality, or early, 1 year, and 5 year graft patency rates. We have concluded that, with the exception of cardiac ischemia warning, our patients without angina, treated surgically, were similar in most important respects to patients in a concurrent series in which angina was one of the indications for operation. We believe that coronary bypass is safe for such individuals without angina and probably as as effective as for those with cardiac pain.