title: Long-term survival after postinfarction bypass operation: early versus late operation.
abstract: 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.
authors.affiliation: Heart Institute, St. Vincent Hospital, Portland, Oregon.
authors.forename: H S
authors.initials: HS
authors.lastname: Floten
authors.forename: A
authors.initials: A
authors.lastname: Ahmad
authors.forename: J S
authors.initials: JS
authors.lastname: Swanson
authors.forename: J A
authors.initials: JA
authors.lastname: Wood
authors.forename: R D
authors.initials: RD
authors.lastname: Chapman
authors.forename: C L
authors.initials: CL
authors.lastname: Fessler
authors.forename: A
authors.initials: A
authors.lastname: Starr
mesh_terms: 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