Late revascularization reduces mortality in survivors of myocardial infarction

In survivors of acute myocardial infarction, the restoration of antegrade flow in the infarct-related coronary artery may improve prognosis by a mechanism that is independent of its influence on left ventricular systolic performance. Furthermore, survival may be improved even when antegrade flow is restored days or even weeks after the acute event. In several retrospective studies of survivors of infarction, we and others have shown a) that long-term survival is substantially better in those with - as opposed to those without - antegrade flow in the infarct-related coronary artery, and b) that the mechanical restoration of flow in an occluded infarct-related artery (accomplished with balloon angioplasty or bypass grafting) markedly improves long-term survival. The late restoration of antegrade flow in the infarct-related artery appears to render the so-called border zone of infarction less electrically unstable, thereby reducing the likelihood of ventricular tachyarrhythmias and sudden death.