Symptoms of chest pain and dyspnea and factors associated with chest pain and dyspnea 10 years after coronary artery bypass grafting Johan Herlitz, MD, PhD, a Gunnar Brandrup-Wognsen, MD, b Kenneth Caidahl, MD, PhD, c Maria Haglid, MSc, a Marianne Hartford, MD, PhD, d Bjo ¨rn W. Karlson, MD, d Thomas Karlsson, MSc, a and Hele ´n Sjo ¨land, MD, PhD a Göteborg, Stockholm, and Mölndal, Sweden Background The purpose of the study is to describe (a) changes in physical activity and symptoms of chest pain and dyspnea during 10 years after coronary artery bypass grafting (CABG) and (b) risk indicators for chest pain and dyspnea 10 years after CABG. Methods This is a prospective observational study in Western Sweden. The study includes all patients who underwent CABG without simultaneous valve surgery and with no previous CABG between June 1, 1988, and June 1, 1991. All patients were prospectively followed up for 10 years. Evaluation of symptoms took place via postal inquiries before, 5, and 10 years after the operation. Results In all, 2,000 patients participated in a survey evaluating chest pain and dyspnea during 10 years after CABG. The overall 10-year mortality was 32%. The proportion of patients with no chest pain increased from 3% before surgery to 56% 5 years after the operation and 54% after 10 years. There was only one predictor for chest pain after 10 years and that was the duration of angina pectoris before surgery. The proportion of patients with no dyspnea increased from 12% before surgery to 40% after 5 years but decreased to 31% after 10 years. The most significant predictors for dyspnea after 10 years were female sex, obesity, diabetes mellitus, high age, duration of angina pectoris, functional class before CABG, and number of days in intensive care unit after CABG. Conclusion During 10 years after CABG, one third died. After 10 years, 54% of the survivors were free from chest pain and 31% were free from dyspnea. Predictors for chest pain and dyspnea could be defined and reflected age, history, sex, obesity, preoperative complications, and symptom severity. (Am Heart J 2008;156:580-7.) A large number of patients with coronary artery disease are offered coronary artery bypass grafting (CABG). This treatment has been shown to reduce mortality. 1 Many studies have also demonstrated that a large proportion of these patients have a marked improvement in symptoms such as chest pain and dyspnea after CABG. However, with time, relapse is not uncommon. 2,3 This survey describes limitation of physical activity and symptoms of chest pain and dyspnea in a consecutive series of patients having undergone CABG during a 10-year prospective follow-up. Furthermore, predictors of symptoms of chest pain and dyspnea after 10 years are described. We hypothesized that with time an increasing proportion of patients having undergone CABG will have chest pain and dyspnea and that predictors for recurrence of such symptoms could be defined. Methods Patient population Between June 1988 and June 1991, all patients from western Sweden who underwent CABG at the Department of Thoracic and Cardiovascular Surgery at Sahlgrenska University Hospital (Göteborg, Sweden) and at the Scandinavian Heart Center in Göteborg, Sweden, were registered prospectively. These 2 hospitals performed all the CABGs in the western health care region of Sweden with a population of about 1,600,000 at the time. All patients were followed up for at least 10 years after CABG, except for 11 patients who moved abroad during the follow-up period. The selection of patients to CABG during the study period was not uniform, but the rule was presence of angina pectoris From the a Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska University Hospital, Göteborg, Sweden, b Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Göteborg, Sweden, c Department of Clinical Physiology, Sahlgrenska University Hospital and Karolinska Institution, Stockholm, Sweden, and d AstraZeneca R&D, Mölndal, Sweden. Submitted January 9, 2004; accepted April 20, 2008. Reprint requests: Johan Herlitz, MD, PhD, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden. E-mail: johan.herlitz@gu.se 0002-8703/$ - see front matter © 2008, Mosby, Inc. All rights reserved. doi:10.1016/j.ahj.2008.04.017