Late Results Following Emergency Saphenous Vein Bypass Grafting For Unstable Angina

Fifty-five consecutive patients with intermittent resting chest pain persisting more than 24 hours after hospitalization and accompanied by ECG changes representative of ischemia were operated urgently more than one year ago. Recent cases with shorter follow-up are excluded. Twenty-eight patients had single grafts, 23 had double grafts, three had triple grafts, and one a quadruple graft. There were three operative deaths (5%) and one sudden late death (2%). There were six early Mls and three late Mls. Follow-up ranges from 12 to 52 months (mean 24 months) with nine patients followed for four years. Actuarial analysis indicates a projected survival rate of 93% three years postoperative. Twenty-three survivors are Functional Class (FC) I, 19 are FC II, and eight are FC III. Functional class could not be determined in one survivor. Thirty patients had postoperative angiography one week to 32 months postop. 35/51 grafts were patent. Only three patients had no patent grafts. There were no significant differences between mean preoperative and postoperative left ventricular end-diastolic pressures (assessed in 20 patients) or ejection fractions (assessed in ten patients). The extremely low mortality early and late postop (7%), the low incidence of Ml (16%), and the excellent functional results after extended follow-up indicate that emergency saphenous vein bypass grafting is an effective therapy for unstable angina.