Late results following emergency saphenous vein bypass grafting for unstable angina

Fifty five consecutive patients with intermittent resting chest pain persisting more than 24 hr after hospitalization and accompanied by ECG changes representative of ischemia were operated urgently more than one yr ago. Recent cases with shorter followup are excluded. 28 patients had single grafts, 23 had double grafts, 3 had triple grafts, and one a quadruple graft. There were 3 operative deaths (5%) and one sudden late death (2%). There were 6 early MIs and 3 late MIs. Followup ranges from 12 to 52 mth (mean 24 mth) with 9 patients followed for 4 yr. Actuarial analysis indicates a projected survival rate of 93% 3 yr postoperative. 23 survivors are Functional Class (FC) I, 19 are FC II, and 8 are FC III. Functional class could not be determined in one survivor. 30 patients had postoperative angiography one wk to 32 mth postop. 35/51 grafts were patent. Only 3 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 10 patients). The extremely low mortality early and late postop (7%), the low incidence of MI (16%), and the excellent functional results after extended followup indicate that emergency saphenous vein bypass grafting is an effective therapy for unstable angina.