SURGICAL REVASCULARIZATION AFTER ACUTE MYOCARDIAL-INFARCTION

At present no consensus exists regarding the timing of surgical revasc ularization after acute myocardial infarction. Patients admitted with acute myocardial infarction between January 1990 and April 1993 underw ent early cardiac catheterization if they had postinfarction ischemia or positive results on a low-level exercise stress test. If indication s for surgical intervention were found at the time of catheterization, patients were operated on within 1 or 2 days or were discharged and r eturned for the operation within 2 to 3 weeks. During this period, we performed 2175 isolated coronary artery bypass graft procedures; 23 pa tients were operated on within 24 hours of acute myocardial infarction with an operative mortality of 4.4%, 30 patients underwent surgery be tween 24 and 72 hours after infarction with no deaths, 193 patients we re operated on between 3 and 7 days after infarction with an operative mortality of 2.1%, 284 patients underwent revascularization between 1 week and 1 month after infarction with an operative mortality of 1.4% , and the 1645 patients without a recent infarction had a mortality ra te of 1.9%. Multivariate statistical analysis was performed to evaluat e mortality with these independent variables: reoperative surgery, sex , age, diabetes, timing of infarction, location of infarction, and typ e (transmural versus subendocardial). Myocardial infarction at any tim e interval less than 1 month before the operation was not associated w ith mortality when adjusted by these other risk factors. In addition, no differences were noted in length of stay, stroke rate, or prevalenc e of renal failure or pulmonary insufficiency. We conclude that noneme rgency surgical revascularization can be done safely at any time inter val after acute myocardial infarction, certainly after 72 hours, with no increase in operative mortality and acceptable morbidity.