Patients who have had surgery must understand, how¬ever, that the other arteries and points in the coronary artery below the graft can develop further atherosclerosis because the operation does not cure the disease. In addi¬tion, a blood clot (coronary thrombosis) can form in any individual at any time at the site of atheromatous obstruc¬tion without warning. Therefore, coronary bypass surgery does not prevent a second or third heart attack, although it may prevent death in a few.
D. Other Factors Affecting Mortality and Morbidity
Approximately 50% of grafts become blocked after 10 years, particularly in patients who smoke or have hyper¬tension, diabetes, or an LDL cholesterol level greater than 120 mg/dl (3 mmol/L). Thus most patients require treat¬ment with statins to achieve an LDL goal of less than 80 mg/dl (2.0 mmol/L) to maintain patency of grafts which provides relief from angina. Discontinuation of smoking is necessary to prevent the recurrence of angina and improvement in survival.

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