[Coronary revascularization at the acute phase of myocardial infarction. Short and median-term survival of 359 patients. Multicenter study].

Three hundred and fifty nine consecutive patients from 4 different French centres who underwent attempted early coronary revascularisation during the acute phase of myocardial infarction by intracoronary thrombolysis (309 cases) intravenous thrombolysis (26 cases) and transluminal angioplasty (24 cases) were reviewed to evaluate the short and medium term results of these non-surgical techniques. Three groups of patients were identified from the results of initial and secondary coronary angiography: 1) deaths during the procedure (1.9%), 2) successes, with immediate and stable revascularisation (65%), 3) failures, also including initial successes with secondary reocclusion (33.1%). The global mortality at one month was 10.9%. This was significantly lower after revascularisation (p less than 0.001): 4.7% in patients with successful procedures and 17.6% in the others. The one year survival rate was also significantly higher in patients successful revascularisation (93 +/- 4% vs 75 +/- 8%, p less than 0.001). There were more recurrent infarctions and residual angina in patients with successful early coronary revascularisation: 7.7% and 12% respectively vs 4.2% and 8.4% respectively in the other patient group. In the successful group, 200 patients (86%) had one or more stenoses greater than 70% narrowing after coronary revascularisation. The recurrent infarction rate in the 94 patients treated medically was 9% and 17% had residual angina compared to 6% and 10% respectively in the 106 patients referred for coronary bypass surgery or undergoing complementary angioplasty. Three conclusions may be drawn from this non-randomised study of coronary revascularisation during the acute phase of myocardial infarction: attempts at coronary revascularisation do not aggravate the immediate prognosis of myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)