SUMMARY The effects of perioperative myocardial infarction (MI) on long-term survival and symptomatic status after coronary bypass surgery was assessed by a 64.9-month follow-up of the survivors (225) THE GOALS of therapy for coronary atherosclerosis include relief of angina pectoris, modification of the incidence of myocardial infarction, protection against sudden death and increased longevity. Considerable debate has centered on the relative merits of medical and surgical therapy in achieving these goals. The occurrence of perioperative myocardial infarction has been cited as a significant limitation to surgical therapy.This attitude has largely been influenced by the long-term result of naturally occurring myocardial infarction, which is associated with serious morbidity and mortality, especially in subsets of patients with ventricular ectopy.'-3 Further, variable reports of the incidence and significance (mortality) of perioperative myocardial infarction in regard to early and intermediate implications have added to the confusion over this issue. Some of these differences have been an expression of the variable criteria used to make the diagnosis. Recent 1185 nary artery bypass surgery, we performed a long-term follow-up study. Electrocardiographic, enzymatic and scintigraphic criteria were used to diagnose perioperative myocardial infarction.Patients and Methods From November 1975 to July 1976, 227 patients (197 male and 30 female) had isolated coronary artery bypass graft surgery and form the basis for this study. The mean age of this group was 57 years. Based on preoperative historical and ECG findings, 104 (46%) had evidence of previous (more than 2 weeks earlier) myocardial infarction. Coronary arteriography revealed significant coronary disease (50% or greater diameter reduction) in 2.4 vessels per patient; 24 patients (11%) had left main stenosis. The mean Friesinger coronary score (maximum score of 15 points represents total occlusion of all three major vessels) was 11 for our patients.8 The mean ejection fraction calculated from the right anterior oblique ventriculogram was 62%.Anesthesia was induced and maintained using i.v. morphine sulfate and diazepam. Supplementation with a mixture of nitrous oxide (50%) and oxygen (50%) was occasionally used. Nitroprusside by i.v. infusion and small doses of i.v. propranolol (0.5-2.0 mg) were used to blunt the hypertension and tachycardia occasionally seen with endotracheal intubation and stemotomy.The surgical technique at that time included cardiopulmonary bypass with a bubble oxygenator, hemodilution and intermittent aortic cross-clamping, with mild-to-moderate systemic hypothermia. The coldest

99mTc glucoheptonate was used as a brain imaging agent in a consecutive series of 859 patients. Sensitivity was 94% in patients with proved CNS tumors. Static imaging of patients with infarction showed a sensitivity of 62%. When the perfusion study was included, this valve increased to 90%. Overall sensitivity was 83%, specificity 99%, and accuracy 95% without inclusion of perfusion results. When these results were included, overall sensitivity was 93%, specificity 99%, and accuracy 98%.

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