HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Erik Hjelms Poul Alstrup Peter K. Paulsen Henrik Arendrup Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Hjelms, E. Articles by Arendrup, H. Search for Related Content PubMed PubMed Citation Articles by Hjelms, E. Articles by Arendrup, H.

Eur J Cardiothorac Surg 1998;13:555-558
© 1998 Elsevier Science NL

CABG shortly after AMI treated with thrombolysis: an analysis of the surgical group and a comparison with PTCA in the DANAMI study¹

^a Department of Cardiothoracic Surgery, Aalborg, Denmark
^b Department of Cardiothoracic Surgery, Aarhus, Denmark
^c Department of Cardiothoracic Surgery, Gentofte, Denmark
^d Department of Cardiothoracic Surgery, Odense, Denmark
^e Department of Cardiothoracic Surgery, Rigshospitalet Copenhagen, Copenhagen, Denmark

Received 1 October 1997; received in revised form 11 February 1998; accepted 16 February 1998.

Corresponding author. Department of Cardiothoracic Surgery, University Hospital 901 85, Umeå, Sweden. Tel.: +46 907 853676; fax: +46 907 853601.

Objective: To present surgical results of the DANAMI study comparing conservative and invasive treatment of postinfarction myocardial ischaemia and to compare these with percutaneous transluminal angioplasty (PTCA) which was the alternative invasive treatment in that study. Methods: A group of 413 patients with verified acute myocardial infarction treated with thrombolysis within 12 h of the onset of symptoms, who demonstrated postinfarction myocardial ischaemia were treated with coronary bypass grafting (CABG) or PTCA. Patients with left main lesions, three-vessel disease, two-vessel disease with more than three stenoses and patients with occlusions of a non-infarct related vessel had primary CABG. Patients with 1- and 2-vessel disease with not more than a total of three stenoses had PTCA. In case of failed PTCA patients had secondary CABG. The median distance from AMI to CABG was 45 days. PTCA was performed at a mean of 39 days after the infarction. Results: A total of 147 patients had CABG and 266 had PTCA. The operative mortality for CABG was 1.4%. No PTCA patients died in relation to the procedure, 0.8% developed acute myocardial infarction as a consequence of the procedure, 1.5% had acute CABG and 3.5% elective CABG due to failed PTCA. In spite of more severe coronary artery disease among the CABG patients there was no difference in survival at 2.4 years. The CABG group had significantly fewer episodes of unstable angina, 10.2% versus 25.6% (P=0.0002). No CABG patients had re-do revascularisation at 2.4 years follow-up versus15.4% of the PTCA patients. At 3 years 80% of the CABG patients were free of angina compared to the 61% of the PTCA group (P<0.0001). Conclusion: Low morbidity and mortality justifies the deferred elective revascularisation in patients with postinfarction myocardial ischaemia even in patients with silent ischaemia. There is no difference in survival at 2.4 years between CABG and PTCA but CABG offers more lasting results concerning incidence of stable and unstable angina than PTCA, which, however, is a valuable alternative in patients with less severe coronary artery disease.

Key Words: Coronary artery bypass grafting • Postinfarction ischaemia • Percutaneous transluminal angioplasty