SURGICAL MYOCARDIAL REVASCULARIZATION DUR ING THE FIRST 15 DAYS OF EVOLUTION OF ACUTE MYOCARDIAL-INFARCTION

Revascularization significantly improves early and late prognosis in a cute myocardial infarction and has prompted substantial changes in the rapeutic strategies. We report 140 patients aged 60.3 years old (123 m ale) operates within 15 days of sustaining an acute myocardial infarct ion, between January 1984 and December 1989. Coronary angiogram showed single vessel disease in 8 (6%), double vessel disease in 32 (23%), t riple vessel disease in 85 (61%) and left main vessel disease in 13 (9 %). Indications for surgery were postinfarction angina in 92 patients (66%), multiple severe coronary stenoses in 18 (13%), infarction of le ss than six hours from onset in 16 (11%), acute angioplasty failure in 7 (5%) and cardiogenic shock in 7 (5%). Thirty one patients were oper ated during the initial 24 h of infarction (16 with less than 6 h), 14 between the second and third day and 95 between the fourth and fiftee nth day. Overall mortality was 4.3% (6/140). Among patients with faile d angioplasty and cardiogenic shock, mortality was 23% (7/140), among patients with postinfarction angina this figure was 2.1% (2/92). No pa tients operated within 6 hours of infarction onset or due to severe co ronary stenosis died. Ninety seven percent of patients were followed d uring mean of 49 months. Three patients had a new acute myocardial inf arction, two had sudden death and two died of unrelated causes. One re quired angioplasty and none was reoperated. Five years actuarial survi val was 95% and the actuarial probability of being free of acute myoca rdial infarction, angioplasty or reoperation at five years was 99 and 100% respectively. It is concluded that early surgical revascularizati on in acute myocardial infarction is safe and has excellent long term results.