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Perioperative myocardial infarction (PMI) as diagnosed by standard electrocardiograms (appearance of persistent Q-waves of at least 0.4 sec duration) and/or autopsy, occurred in 51 (3.8%) out of 1341 consecutive patients undergoing coronary artery bypass surgery using saphenous vein grafts. Retrospective analysis of the available data revealed that preoperative factors like sex, age, history of myocardial infarction, functional class, coronary risk factors, number of vessels diseased, and ventricular function had no influence on the incidence of PMI. However, intraoperative parameters, e.g., type and duration of cardiac arrest as well as technical errors leading to graft occlusion, significantly affected the incidence of PMI. The clinical relevance of PMI is indicated by a high early mortality of 25.5% as compared to 2.3% in patients without PMI. Improvement as well as complete alleviation of angina pectoris was less frequent in patients with PMI than in patients without PMI. The decrease in the rate of PMI from more than 18% in 1970 to less than 1% in 1978/79 confirms that such incidents should not be regarded as an inevitable risk but as a complication which can largely be avoided by proper operative technique.

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One thousand ninety-six consecutive patients treated with aorta-to-coronary-vein bypass grafts were followed up to 4 years postoperatively. Early mortality was 1.7 %, overall 4-year survival rate, computed by actuarial methods, was 93.1 %. The incidence of perioperative myocardial infarction was 1.9 %. After 4 years 94.4 % of the patients were free of peri/postoperative infarcts. Angina pectoris was eliminated in 64.3 % of the survivors during the first and in 48.5 % during the fourth postoperative year. The influence of number of grafts, degree of revascularization, aortic cross-clamp time, graft patency and postoperative anticoagulation upon the operative results was studied. Graft occlusion proved to be the single most important factor influencing mortality as well as infarction rate and symptomatic improvement. The patency rate of 476 bypass veins, determined by angiography at a mean of 7 months postoperatively, was 91.8 %. Grafts with an intraoperatively measured flow of 40 ml/ min or less, grafts constructed to the postero-lateral branch of the circumflex coronary artery, and grafts attached to coronary arteries with a lumen caliber of less than 1.5 mm at the site of the anastomosis showed comparatively high occlusion rates. Postoperative anticoagulants had no effect upon graft patency.