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document
Ten-year incidence of myocardial infarction and prognosis after infarction . Department of Veterans Affairs Cooperative Study of Coronary Artery Bypass Surgery . BACKGROUND The 10-year incidence of myocardial infarction ( fatal and nonfatal ) and the prognosis after infarction were evaluated in 686 patients with stable angina who were randomly assigned to medical or surgical treatment in the Veterans Administration Cooperative Study of Coronary Artery Bypass Surgery . METHODS AND RESULTS Myocardial infarction was defined by either new Q wave findings or clinical symptoms compatible with myocardial infarction accompanied by serum enzyme elevations with or without electrocardiographic findings . Treatment comparisons were made according to original treatment assignment ; 35 % of the medical cohort had bypass surgery during the 10-year follow-up period . The overall cumulative infarction rate was somewhat higher in patients assigned to surgery ( 36 % ) than in medical patients ( 31 % ) ( p = 0.13 ) due to perioperative infarctions ( 13 % ) and an accelerated infarction rate after the fifth year of follow-up ( average , 2.4 % /yr in the surgical group versus 1.4 % /yr in the medical group ) . The 10-year cumulative incidence of death or myocardial infarction was also higher in surgical ( 54 % ) than in medical ( 49 % ) patients ( p = 0.20 ) . According to the Cox model , the estimated risk of death after infarction was 59 % lower in surgical than in medical patients ( p less than 0.0001 ) . The reduction in postinfarction mortality with surgery was most striking in the first month after the event : 99 % in the first month ( p less than 0.0001 ) and 49 % subsequently ( p less than 0.0001 ) . The estimated risk of death in the absence of infarction was nearly identical regardless of treatment ( p = 0.75 ) . Exclusion of perioperative infarctions did not alter the findings . CONCLUSIONS Although surgery does not reduce the incidence of myocardial infarction overall , it does reduce the risk of mortality after infarction , particularly in the first 30 days after the event ( fatal infarctions ) .
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Intervention_Surgical
medical
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Intervention_Surgical
surgical treatment
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Intervention_Surgical
bypass surgery
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Intervention_Surgical
surgery
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Outcome_Physical
overall cumulative infarction rate
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Outcome_Physical
accelerated infarction rate
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Outcome_Mortality
10-year cumulative incidence of death
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Outcome_Mortality
myocardial infarction
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Outcome_Mortality
estimated risk of death after infarction
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Outcome_Other
reduction
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Outcome_Mortality
postinfarction mortality
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Outcome_Mortality
risk of death in the absence of infarction
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Outcome_Physical
myocardial infarction
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Outcome_Mortality
mortality
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Participant_Sample-size
686
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Participant_Condition
stable angina
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Participant_Condition
myocardial infarction