Aorta-coronary bypass in patients with coronary artery disease who do not have angina

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.