Surgical revascularization after fibrinolysis in acute myocardial infarction: Long-term follow-up

One hundred twenty-eight patients with myocardial infarction who underwent operation for myocardial revascularization and 147 patients who received medical therapy were followed up for up to 6 years: all patients had received treatment with intravenous streptokinase. In the surgical group, 91.5 % of the patients had the region related to the infarction revascularized, and in 82.8% of them the mammary artery was used. Statistically significant differences were not detected between the groups according to infarct size, clinical features, and left ventricular ejection fraction. However, there was a higher risk in the surgical group, as compared with that in the medical group, in terms of anatomic characteristics: 99.2 % versus 77.1 % of the patients showed more than 70 % residual obstruction at the "culprit" coronary artery ( p p p = 0.096, 95 % confidence interval -0.2% to 12.6%). Significantly higher survivals were obtained for the surgical group both during the first (93 % ± 2.3 % versus 80.3 % ± 3.3 %, p = 0.005) and the sixth (86.4 % ± 3.4 % versus 68.4 % ± 4.3 %, p = 0.003) year of follow-up. Statistically significant differences were also obtained when in-hospital deaths were excluded. A Cox regression model with 13 variables showed that only age ( p = 0.0422) and medical treatment ( p = 0.0194) correlated independently with mortality. It is concluded that in this nonrandomized study, operation led to a significantly higher survival both on a medium- and long-term basis, when compared with that obtained for patients receiving medical therapy.