Early myocardial revascularization for postinfarction angina: Results and long-term follow-up

Abstract

Within 30 days of acute myocardial infarction, 108 consecutive patients underwent urgent surgical myocardial revascularization for postinfarction angina between July 1976 and March 1983. There were 84 men and 24 women whose mean age was 59.6 +/- 9.5 years (range 34 to 80). Group I (15 patients, 14%) underwent surgery within 48 hours, Group II (47 patients, 43%) between 3 and 7 days and Group III (46 patients, 43%) within 30 days. Fifty-nine patients (55%) had transmural infarction. The ejection fraction was less than 40% in 21 patients (19%). Left ventricular end-diastolic pressure was 20 mm Hg or greater in 42 patients (39%). The incidence of single, double, triple vessel and 70% or greater left main coronary artery stenosis was 4, 20, 59 and 17%, respectively. There were two deaths (1.8%) within 30 days of operation. The incidence of intraaortic balloon pumping was higher in patients operated on earlier after myocardial infarction (53% of Group I versus 22% of Group III). Statistically, there were no differences in the use of inotropic agents or the occurrence of arrhythmias or postoperative myocardial infarction in the three groups. Late follow-up (mean 35 months, range 18 to 98) is complete for all patients (100%). There were four late myocardial infarctions and eight deaths. Actuarial survival was 87% at 5 years. Seventy-three percent of the 108 patients were free of angina and the condition of 14% improved. These results indicate that myocardial revascularization in the first 30 days after myocardial infarction can be accomplished with morbidity and mortality rates similar to those of an elective operation for chronic angina refractory to medical management.

Cardiac catheterization for patients with postinfarction angina

“…Surgical series of patients with postinfarction angina report triple-vessel disease in 3 1-94% and left main disease in 7-20 % . [13][14][15][16][17][18] The selection bias in these series is obvious. Nevertheless, when we looked at our patients who were revascularized, the incidence of triple-vessel and left main disease combined increased to only 30%.…”

Surgical Treatment of Acute Myocardial Infarction

“…Armed with these data, surgeons and car diologists began the aggressive treatment of postinfarction angina by coronary bypass surgery with a subsequent apparent decrease in the number of patients presenting with cardiogenic shock from extension of myocar dial infarction [9], Postinfarction angina is treated as aggressively as preinfarction or unstable angina by intensive medical thera py. It is apparent that in a large number of cases medical therapy alone may completely quell the symptomatology and ECG find ings, and surgery may be recommended after a semielective cardiac catheterization and a period of evaluation.…”

Indications for coronary angioplasty in acute myocardial ischemic syndromes

“…Recent reports [34][35][36][37][38][39] have suggested that myocardial revascularization within the first 30 days after myocardial infarction can be accomplished with an acceptable operative mortality in selected patients, although overall mortality and morbidity rates are higher than those reported for elective surgery. Accordingly, current strategy for the management of patients with early postinfarction angina is aimed at delaying surgery until such a time when it can be performed with less inherent risks.…”