SURGICAL RESTORATION OF ANTEGRADE FLOW IN THE OCCLUDED INFARCT ARTERYIMPROVES LONG-TERM SURVIVAL IN PATIENTS WITH MULTIVESSEL CORONARY-ARTERY DISEASE

Background: Previous studies have shown that survival after myocardial infarction is strongly influenced by the presence or absence of anteg rade flow in the infarct artery: patients with antegrade flow have a h igher survival rate than those whose infarct artery remains occluded. In patients with an occluded infarct artery and no other coronary arte ry disease (single-vessel disease), the mechanical restoration of ante grade flow - via balloon angioplasty or coronary artery bypass graftin g - improves long-term survival. This study was carried out in order t o assess the influence of bypass grafting on long-term prognosis in su rvivors of myocardial infarction who had an occluded infarct artery an d stenoses of one or both remaining arteries (multivessel disease). Me thods: Over a 10-year period, 157 survivors of first infarction (95 me n and 62 women, aged 30-78 years) with an occluded infarct artery and stenoses of one or both remaining arteries were identified. Of these, 91 (group 1) were treated medically, and 66 (group 2) underwent multiv essel bypass grafting. Results: The two groups were similar in age, se x, and extent of coronary artery disease. Over 62 +/- 35 months of fol low-up, 42 (46%) of the 91 medically treated (group 1) patients died o f cardiac causes compared with only 12 (18%) of the 66 surgically trea ted (group 2) patients (P= 0.023). Multivariate analysis showed that t he significant predictors of survival were left ventricular ejection f raction, patient age, extent of coronary artery disease, and bypass gr afting. Conclusion: In survivors of myocardial infarction with an occl uded infarct artery and multivessel coronary artery disease, coronary artery bypass grafting is associated with improved long-term survival.