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

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.