Coronary bypass operation following acute complicated myocardial infarction

Abstract

The indications for operation to correct acute mechanical defects after myocardial infarction are clearly established. Less clear is the use of surgical procedures for nonmechanical complications such as persistent ischemia or circulatory collapse. Between 1974 and 1981, 80 patients underwent coronary artery bypass grafting (CABG) within 2 weeks of infarction. Continued pain was the indication in 83% and cardiogenic shock in 17%. Seventeen patients were operated upon within 24 hours of infarction, 35 from 1 to 7 days, and 28 from 8 to 14 days. Eighty-one percent were men; mean age was 58 years. In 39% of patients the infarction was the premier symptom of coronary artery disease. Sixty-two percent had impaired left ventricular function as judged by left ventricular end-diastolic pressure greater than 15 mm Hg or abnormal wall motion seen on ventriculogram. Overall operative mortality was 5.0%; early mortality by indication was 3.0% for pain and 14.3% for shock. Operation for pain carried a 7.7% mortality if done within 48 hours of infarction and was 0% for those patients operated upon after that time. The status of 90% of all patients was known as of December, 1981, with a mean follow-up of 2.9 years. Life-table analysis demonstrates a 5 year survival rate of 85% +/- 6% in the group operated upon for pain. CABG in the immediate postinfarction period can be done safely with a 5 year survival in patients without hemodynamic compromise comparable to that of patients with chronic angina undergoing elective operation. These results should encourage the application of early postinfarction CABG in other high-risk subgroups of patients.