FATAL MYOCARDIAL-INFARCTION FOLLOWING LOWER-EXTREMITY REVASCULARIZATION - 273 PATIENTS FOLLOWED 6 TO 11 POSTOPERATIVE YEARS

Abstract

Routine preoperative coronary angiography was recommended to all patients scheduled for elective lower extremity revascularization. Patients found to have severe, correctable coronary artery disease (CAD) are advised to undergo myocardial revascularization prior to surgical management of lower extremity ischemia in an attempt to reduce the incidence of fatal postoperative myocardial infarction. To provide an historic standard with which the results of this approach may eventually be compared, complete follow-up information was obtained for 95% 0f 273 consecutive patients who underwent lower extremity revascularization. Fatal myocardial infarction accounted for 52% of early postoperative deaths and occurred in 3.3% of the entire series. Among rhe patients who survived operation, the 5 year mortality rate was 20% and the 11 yr mortality rate was 40%. Complications of CAD caused 50% of the deaths that occurred within 5 yr post-operatively and 55% of the deaths that have occurred within 11 yr. The incidence of fatal myocardial infarction within 5 yr after operation among patients who had preoperative evidence of CAD was statistically significant (P < 0.01).