Cirugía de revascularización miocárdica en los primeros 15 días de evolución del infarto / Miocardial revascularization surgery in the first 15 days of infarction evolution

ABSTRACT

Revascularization significantly improves early and late prognosis in acute myocardial infarction and has prompted substantial changes in therapeutic strategies. We report 140 patients aged 60.3 years old (123 male) operated within 15 days of sustaining an acute myocardial infarction, between january 1984 and december 1989. Coronary angiogram showed single vessel disease single vessel disease in 8 (6 percent), double vessel disease in 32 (23 percent), triple vessel disease in 85 (61 percent) and left main vessel disease in 13 (9 percent). Indications for surgery were ponstinfarction angina in 92 patients (66 percent), multiple severe coronary stenosis in 18 (13 percent), infarction of less than six hours from onset in 16 (11 percent), acute angioplasty failure in 7 (5 percent) and cardiogenic shock in 7 (5 percent). Thirty one patients were operated 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 fifteenth day. Overall mortality was 4.3 percent (6/140). Among patients with failed angioplasty and cardiogenic shock, mortality was 23 percent (7/140), among patients with postinfarction angina this figure was 2.1 percent (2/92). Five years actuarial survival was 95 percent and the actuarial probability of being free of acute myocardial infarction, angioplasty or reoperation at five years was 99 and 100 percent respectively. It is concluded that early surgical revascularization in acute myocardial infarction is safe and has excellent long term results: