Operative intervention for postinfarction angina.

Thirty-four patients (26 men and 8 women) underwent myocardial revascularization following myocardial infarction (MI) at the Johns Hopkins Hospital during 1980 through 1982. Average age was 59 years. Of the 33 patients with unstable angina, 61% had ischemia in the infarct zone and 39% had "ischemia at a distance." Mean time from MI to operation was 16 days. The MIs were equally divided between a transmural and a subendocardial location. Eleven patients had a history of congestive heart failure. Intraaortic balloon pumping was used preoperatively for anginal stabilization in 14 patients. Mean ejection fraction for the group was 52%. There were 3 operative deaths, all 3 due to myocardial failure. Late follow-up (mean, 13.7 months; range, 6 to 35 months) is complete for 28 patients. There was 1 late death, secondary to cardiac failure. There were no late MIs. Angina had recurred in 5 patients, but only 2 were taking antianginal medication. At the time of follow-up, 52% of patients were in New York Heart Association Functional Class I. This experience suggests that operative intervention for postinfarction angina can be accomplished with an acceptable mortality and thereby increase survival, reduce the later occurrence of MI, and relieve angina in this high-risk group.