Long-term survival after postinfarction bypass operation: Early versus late operation

A study of 832 patients operated on within 30 days of infarction from 1974 to 1987 has resulted in 2,388 patient-years (maximum, 14 years) of prospectivey acquired follow-up. This study excludes 74 parents in whom cardiogenic shock was the indication for operation. Five-year survival (± standard error) was 84% ± 2%, 85% ± 1%, and 90% ± 1%, and 10-year survival was 71% ± 4%, 68% ± 1%, and 78% ± 1% for patients with acute infarction, remote infarction, and no previous infarction, respectively. Age and left ventricular end-diastolic pressure significantly affected long-term survival for patients with acute infarction by both univariate and multivariate analysis. For patients aged less than 65 years, the 5-year and 10-year actuarial survival rates were 89% ± 2% and 80% ± 4%, compared with 75% ± 3% and 58% ± 9%, respectively, for patients aged more trun 65 years. The survival percentages were 89% ± 2% and 75% ± 6% for patients with left ventricular end-diastolic pressure less than 15 mm Hg compared with 77% ± 5% and 67% ± 7% for patients with left ventricular end-diastolic pressure greater than 15 mm Hg. Operative mortality was 7.6% for patients operated on within 24 hours, compared with 4.1% for patients operated on between 2 and 30 days after infarction. Ten-year survival was similar (about 70%) for all timing groups. Based on these long-term results, there appears to be little to gain by delaying coronary artery bypass grafting, when indicated, after infarction occurs.