Circulation, Vol 83, 747-755, Copyright © 1991 by American Heart Association
P Peduzzi, K Detre, ML Murphy, J Thomsen, H Hultgren and T Takaro
BACKGROUND. The 10-year incidence of myocardial infarction (fatal and
nonfatal) and the prognosis after infarction were evaluated in 686 patients
with stable angina who were randomly assigned to medical or surgical
treatment in the Veterans Administration Cooperative Study of Coronary
Artery Bypass Surgery. METHODS AND RESULTS. Myocardial infarction was
defined by either new Q wave findings or clinical symptoms compatible with
myocardial infarction accompanied by serum enzyme elevations with or
without electrocardiographic findings. Treatment comparisons were made
according to original treatment assignment; 35% of the medical cohort had
bypass surgery during the 10- year follow-up period. The overall cumulative
infarction rate was somewhat higher in patients assigned to surgery (36%)
than in medical patients (31%) (p = 0.13) due to perioperative infarctions
(13%) and an accelerated infarction rate after the fifth year of follow-up
(average, 2.4%/yr in the surgical group versus 1.4%/yr in the medical
group). The 10-year cumulative incidence of death or myocardial infarction
was also higher in surgical (54%) than in medical (49%) patients (p =
0.20). According to the Cox model, the estimated risk of death after
infarction was 59% lower in surgical than in medical patients (p less than
0.0001). The reduction in postinfarction mortality with surgery was most
striking in the first month after the event: 99% in the first month (p less
than 0.0001) and 49% subsequently (p less than 0.0001). The estimated risk
of death in the absence of infarction was nearly identical regardless of
treatment (p = 0.75). Exclusion of perioperative infarctions did not alter
the findings. CONCLUSIONS. Although surgery does not reduce the incidence
of myocardial infarction overall, it does reduce the risk of mortality
after infarction, particularly in the first 30 days after the event (fatal
infarctions).
ARTICLES
Ten-year incidence of myocardial infarction and prognosis after infarction. Department of Veterans Affairs Cooperative Study of Coronary Artery Bypass Surgery
VA Medical Center, West Haven, CT 06516.
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