Coronary bypass for relief of persistent pain following acute myocardial infarction.

Between January, 1976, and April, 1980, 116 patients had urgent myocardial revascularization for clinical instability within 30 days of acute myocardial infarction (MI). Group 1 (8 patients) had coronary bypass grafting within 24 hours of acute MI; Group 2 (20 patients) had coronary bypass grafting 2 to 7 days after acute MI; and Group 3 (88 patients) had coronary bypass grafting 8 to 30 days after infarction. Indications for operation were persistent or recurrent pain (81%), pain plus ventricular arrhythmias (12%), and pain plus compelling anatomy. The incidence of single-vessel, triple-vessel, and left main coronary artery disease was 28%, 31%, and 12%, respectively. There were no hospital deaths in the series. The incidence of inotropic requirements, postoperative intraaortic balloon pumping, ventricular arrhythmias, and perioperative infarction was higher in patients operated on within 7 days of acute MI than for patients having coronary bypass grafting after this time. There have been 5 late deaths during a mean follow-up of 14 months. Actuarial survival was 97% at 18 months. Seventy-one percent of patients are presently pain free. Graft patency was 84% in 17 patients recatheterized after coronary bypass grafting and in 14 patients, grafts placed into the area of infarction were patent. This study suggests that the frequency of perioperative complications will be increased in patients operated on within one week of MI, but after this period, coronary bypass grafting can be accomplished with the same morbidity as the of elective operation.