Similar long-term outcome for arterial myocardial revascularization performed after or within the first seven day of acute myocardial infarction

Abstract

The current practice of myocardial revascularization for acute myocardial infarction (MI) is primary percutaneous intervention (PCI). Surgical revascularization (“bypass”) is reserved for patients unsuitable for PCI. The purpose of this report is to describe the long-term outcome of acute MI patients who underwent left-sided arterial revascularization (left anterior descending and circumflex arteries) before PCI was adopted as the preferred treatment for this subset of patients. Between 1996 and 2002, 434 consecutive patients in our center underwent myocardial revascularization for recent MI using the composite T-graft technique (381 bilateral internal thoracic arteries and 53 single internal thoracic artery and radial arteries). Two-hundred and seventy-six patients were operated on within seven days of an acute MI (Group A) and the remaining 158 patients were operated on after the 7 th day since an acute MI (Group B). Group A had significantly increased operative mortality (6.5% vs 1.3% for Group B, P = 0.012). Surgery performed within the first week of an acute MI was also found to be a significant predictor of early mortality in multivariate logistic regression analysis (O.R. 10.31; 95% C.I. 1.32-83.30, P = 0.026). The mean follow-up was 10.6 ± 5.2 years. The Kaplan Meier 10-year survival of the two groups, however, was similar (65.6 ± 2.9 Group A vs 64.6 ± 3.8 Group B, P = 0.953), and assignment to Group A was not an independent predictor of decreased survival (P = 0.395, Cox model). When using arterial grafts for myocardial revascularization, the long-term outcome of pa tients operated on during the first 7 days of acute MI is not worse than that of patients operated on after more than 7 days, despite their increased operative mortality.