Fatal myocardial infarction following lower extremity revascularization. Two hundred seventy-three patients followed six to eleven postoperative years.

Routine preoperative coronary angiography has been recommended to all patients scheduled for elective lower extremity revascularization at the Cleveland Clinic since 1978. Patients found to have severe, correctable coronary artery disease (CAD) have been advised to undergo myocardial revascularization prior to surgical management of lower extremity ischemia in an attempt to reduce the incidence of fatal postoperative myocardial infarction. In order to provide an historic standard with which the results of this approach may eventually be compared, complete follow-up information has been obtained for 95% of 273 consecutive patients who underwent lower extremity revascularization between 1969 and 1973. Fatal myocardial infarction accounted for 52% of early postoperative deaths and occurred in 3.3% of the entire series. Among the patients who survived operation, the five-year mortality rate was 20% and the 11-year mortality rate was 40%. Complications of CAD caused 50% of the deaths that occurred within five years postoperatively and 55% of the deaths that have occurred within 11 years. The incidence of fatal myocardial infarction within five years after operation among patients who had preoperatively evidence of CAD was statistically significant (p less than 0.01).