Surgical restoration of antegrade flow in the occluded infarct artery improves long-term survival in patients with multivessel coronary artery disease

BACKGROUND: Previous studies have shown that survival after myocardial infarction is strongly influenced by the presence or absence of antegrade flow in the infarct artery: patients with antegrade flow have a higher survival rate than those whose infarct artery remains occluded. In patients with an occluded infarct artery and no other coronary artery disease (single-vessel disease), the mechanical restoration of antegrade flow--via balloon angioplasty or coronary artery bypass grafting--improves long-term survival. This study was carried out in order to assess the influence of bypass grafting on long-term prognosis in survivors of myocardial infarction who had an occluded infarct artery and stenoses of one or both remaining arteries (multivessel disease). METHODS: Over a 10-year period, 157 survivors of first infarction (95 men and 62 women, aged 30-78 years) with an occluded infarct artery and stenoses of one or both remaining arteries were identified. Of these, 91 (group 1) were treated medically, and 66 (group 2) underwent multivessel bypass grafting. RESULTS: The two groups were similar in age, sex, and extent of coronary artery disease. Over 62 +/- 35 months of follow-up, 42 (46%) of the 91 medically treated (group 1) patients died of cardiac causes compared with only 12 (18%) of the 66 surgically treated (group 2) patients (P = 0.023). Multivariate analysis showed that the significant predictors of survival were left ventricular ejection fraction, patient age, extent of coronary artery disease, and bypass grafting. CONCLUSION: In survivors of myocardial infarction with an occluded infarct artery and multivessel coronary artery disease, coronary artery bypass grafting is associated with improved long-term survival.