Does restoration of antegrade flow in the infarct-related coronary artery days to weeks after myocardial infarction improve long-term survival?

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Abstract
Background Previous studies have shown that survival after myocardial infarction is influenced by the presence or absence of antegrade flow in the infarct-related artery: patients with antegrade flow have a good prognosis, whereas those whose infarct-related artery is occluded are less likely to survive. Because revascularization– via bypass grafting or angioplasty–is an effective means of reestablishing flow in the infarct-related artery, this study was done to assess the influence of revascularization in the days to weeks after infarction on long-term mortality in survivors of infarction who have an occluded infarct-related artery. Methods Over a 13-year period, 200 subjects (137 men, 63 women, aged 25 to 76 years) with their first infarction, no or minimal antegrade perfusion of the infarct-related coronary artery, and no disease of other arteries were followed for 42 ± 30 months. Of these, 148 (group I) were treated medically, whereas 52 (group II) had bypass grafting (n = 20) or angioplasty (n = 32) of the infarct-related artery. Results The groups were similar in age, sex, infarct-related artery, and left ventricular ejection fraction. Of the 148 group I subjects, 24 (16%) had cardiac-related mortality. In contrast, only one (2%) of the 52 group II subjects died of cardiac causes (P= 0.008). This difference was especially marked in patients with disease of the left anterior descending or left circumflex coronary arteries. Conclusions Thus, in survivors of myocardial infarction with limited or no antegrade flow in the infarct-related artery, mechanical restoration of antegrade perfusion may improve survival.

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