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October 17, 1980

Recurrence of Variant Angina After Bypass Surgery

JAMA. 1980;244(16):1833. doi:10.1001/jama.1980.03310160049029

Nothing can be more disconcerting to a patient who has undergone coronary artery bypass surgery than the reappearance of angina. If angina recurs within a year of the operation, it is usually due to closure of a patent graft. If it recurs five to seven years after grafting, the angina is generally attributed to progressive atherosclerotic changes in the native coronary circulation.

Less well defined in time and rarely thought of in the context of postsurgical recurrence is Prinzmetal variant angina. Waters and associates1 observed such recurrences in six patients during a period of 22 months. Although these patients recalled having had angina at rest before bypass grafting, this symptom was usually overshadowed by the more frequent angina experienced during effort and thus ignored. The reappearing angina was diagnosed as Prinzmetal variant on the basis of chest pain occurring at rest and associated with S-T segment elevation on the