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Early myocardial revascularization for postinfarction angina: results and long-term follow-up
Insights
Urgent surgical myocardial revascularization within 30 days of myocardial infarction is safe and effective. This study shows low mortality and morbidity, with significant improvement in angina symptoms for most patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Postinfarction angina following acute myocardial infarction presents a significant clinical challenge.
- Urgent surgical myocardial revascularization is a potential treatment option for refractory postinfarction angina.
Purpose of the Study:
- To evaluate the safety and efficacy of urgent surgical myocardial revascularization within 30 days of acute myocardial infarction.
- To compare outcomes based on the timing of revascularization (within 48 hours, 3-7 days, or within 30 days).
Main Methods:
- A consecutive series of 108 patients underwent urgent surgical myocardial revascularization for postinfarction angina.
- Patients were grouped based on the timing of surgery post-myocardial infarction.
- Clinical data, including demographics, infarction characteristics, coronary artery disease severity, and procedural outcomes, were collected.
Main Results:
- The overall in-hospital mortality rate was low at 1.8% (2 deaths).
- Actuarial survival was 87% at 5 years, with 73% of patients free of angina and 14% improved at late follow-up.
- No statistically significant differences were observed in arrhythmias or postoperative myocardial infarction across the timing groups.
Conclusions:
- Urgent surgical myocardial revascularization within 30 days of acute myocardial infarction can be performed with morbidity and mortality rates comparable to elective surgery for chronic angina.
- Early revascularization appears safe and effective in managing postinfarction angina, improving long-term survival and symptom relief.
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.