PREDICTORS FOR RECURRENT CHEST PAIN AND RELATIONSHIP TO MYOCARDIAL-ISCHEMIA DURING LONG-TERM FOLLOW-UP AFTER CORONARY-ARTERY BYPASS-GRAFTING

Objective: To describe the impact of coronary artery bypass grafting o n chest pain during 2 years of follow-up after the operation and to id entify predictors of chest pain and its relationship to myocardial isc haemia years after the operation. Methods: Patients were approached wi th a questionnaire at the time of corollary angiography (1291) and 3 m onths (1664), 1 year (1638) and 2 years (1613) after coronary artery b ypass grafting. Two years after the operation, a computerised 12-lead electrocardiogram was obtained during a standardised bicycle exercise rest (618). Results: Prior to surgery. 37% of the patients were unable to perform physical activity compared with 6% after the operation (P < 0.0001 for change in degree of limitation). Only 3% had no chest pai n at all prior to the operation, while 58% of the patients were free f rom chest pain 2 years after surgery (P < 0.0001). We found no correla tion between patients reporting chest pain and signs of ischaemia at e xercise lest, but there was a highly significant correlation with ches t pain Juring the exercise test (P < 0.0001). Independent predictors o f chest pain were severity of preoperative angina (P < 0.0001), younge r age (P = 0.0009), previous coronary artery bypass grafting (P = 0.00 3), duration of symptoms (P = 0.005), the need for prolonged cardiopul monary bypass (P = 0.04) and the absence of left main stenosis (P = 0. 04). Conclusion. Independent predictors of chest pain were indentified 2 years after coronary artery bypass grafting. There was a dramatic i mprovement after coronary artery bypass grafting. However, almost half the patients complained of some kind of chest pain even after the ope ration. This chest pain correlated well with chest pain during the exe rcise test but not with signs of myocardial ischaemia. (C) 1997 Elsevi er Science B.V.