Long-term survival after postinfarction bypass operation: early versus late operation.
A study of 832 patients operated on within 30 days of infarction from 1974 to 1987 has resulted in 2,388 patient-years (maximum, 14 years) of prospectively acquired follow-up. This study excludes 74 patients in whom cardiogenic shock was the indication for operation. Five-year survival (+/- standard error) was 84% +/- 2%, 85% +/- 1%, and 90% +/- 1%, and 10-year survival was 71% +/- 4%, 68% +/- 1%, and 78% +/- 1% for patients with acute infarction, remote infarction, and no previous infarction, respectively. Age and left ventricular end-diastolic pressure significantly affected long-term survival for patients with acute infarction by both univariate and multivariate analysis. For patients aged less than 65 years, the 5-year and 10-year actuarial survival rates were 89% +/- 2% and 80% +/- 4%, compared with 75% +/- 3% and 58% +/- 9%, respectively, for patients aged more than 65 years. The survival percentages were 89% +/- 2% and 75% +/- 6% for patients with left ventricular end-diastolic pressure less than 15 mm Hg compared with 77% +/- 5% and 67% +/- 7% for patients with left ventricular end-diastolic pressure greater than 15 mm Hg. Operative mortality was 7.6% for patients operated on within 24 hours, compared with 4.1% for patients operated on between 2 and 30 days after infarction. Ten-year survival was similar (about 70%) for all timing groups. Based on these long-term results, there appears to be little to gain by delaying coronary artery bypass grafting, when indicated, after infarction occurs.
Floten
H S
HS
Heart Institute, St. Vincent Hospital, Portland, Oregon.
Ahmad
A
A
Swanson
J S
JS
Wood
J A
JA
Chapman
R D
RD
Fessler
C L
CL
Starr
A
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000601:surgery*; D011446:Prospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D015996:Survival Rate; D013997:Time Factors