Internal mammary artery bypass: effect on longevity and recurrent angina pectoris in 2900 patients.

Internal mammary artery bypass (IMA) to the anterior descending coronary artery was performed in 2900 patients from January 1978 to December 1987. The average age of the patients was 64 years. Males accounted for 68% (1972 patients) and 82% (2378 patients) were in New York Heart Association (NYHA) class III. Left ventricular function was impaired in 51%. The average number of additional saphenous vein grafts per patient was 1.8. The operative mortality was 1.6%. Mediastinitis occurred in 29 patients (1%). Reoperation for bleeding was necessary in 32 patients (1.1%). Perioperative myocardial infarction (MI) was seen in 58 patients (2%) and neurological complications occurred in 32 patients (1.1%). Repeat coronary angiography was performed in 703 patients (25%) and demonstrated a patency rate of 96% in IMA grafts and 81% in saphenous vein grafts (SVG). Survival at 9 years was 90% from all causes and 95% when noncardiac deaths were excluded. Recurrence of angina occurred in 522 patients (18%) and reoperation was performed in 15 patients (0.5%). During the same time period, 1783 patients underwent coronary artery bypass utilizing a SVG. Survival at 9 years was 78% from all causes and 83% when noncardiac deaths were excluded. Recurrent angina was present in 546 patients (39%). These data suggest that a patent-IMA to the anterior descending protects against recurrent angina and death from cardiac causes and should be the conduit of choice.