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J Thorac Cardiovasc Surg 1994;107:1454-1459
© 1994 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

Surgical revascularization after fibrinolysis in acute myocardial infarctionLong-term follow-up

São José do Rio Preto, Brazil

From the Instituto de Moléstias Cardiovasculares, São José do Rio Preto, Brazil.

Received for publication June 2, 1993. Accepted for publication Nov. 2, 1993. Address for reprints: José Carlos Nicolau, MD, Instituto de Moléstias Cardiovasculares, Rua Castelo D'Agua, 3030, São José do Rio Preto, 15015-210, Brazil.

Abstract

One hundred twenty-eight patients with myocardial infarction who underwent operation for myocardial revascularization and 147 patients who received medical therapy were followed up for up to 6 years: all patients had received treatment with intravenous streptokinase. In the surgical group, 91.5% of the patients had the region related to the infarction revascularized, and in 82.8% of them the mammary artery was used. Statistically significant differences were not detected between the groups according to infarct size, clinical features, and left ventricular ejection fraction. However, there was a higher risk in the surgical group, as compared with that in the medical group, in terms of anatomic characteristics: 99.2% versus 77.1% of the patients showed more than 70% residual obstruction at the "culprit" coronary artery ( p < 0.001, 95% confidence interval 14.1% to 30.1%) and 76.8% versus 40.7% showed multivessel coronary disease ( p < 0.001, 95% confidence interval 23.7% to 48.5%). In-hospital survival was 95.3% in the surgical group and 89.1% in the medical group ( p = 0.096, 95% confidence interval -0.2% to 12.6%). Significantly higher survivals were obtained for the surgical group both during the first (93% ± 2.3% versus 80.3% ± 3.3%, p = 0.005) and the sixth (86.4% ± 3.4% versus 68.4% ± 4.3%, p = 0.003) year of follow-up. Statistically significant differences were also obtained when in-hospital deaths were excluded. A Cox regression model with 13 variables showed that only age ( p = 0.0422) and medical treatment ( p = 0.0194) correlated independently with mortality. It is concluded that in this nonrandomized study, operation led to a significantly higher survival both on a medium- and long-term basis, when compared with that obtained for patients receiving medical therapy. (J THORAC CARDIOVASC SURG 1994;107:1454-9)

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