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October 26, 1984

Cardiothoracic Surgery

JAMA. 1984;252(16):2234-2237. doi:10.1001/jama.1984.03350160102030

There has been a resurgence of interest in the use of the internal mammary artery for coronary bypass grafting.1-3 An average patency rate of 94.1% at 60 to 100 months following internal mammary artery grafting of the left anterior descending artery has been reported.4 Difficulties with anastomosis and pedicle injury during preparation can be reduced to 2% or less by introducing magnification and microsurgical technique.

Emergency revascularization of the early acute myocardial infarct continues to receive much attention. In a ten-year follow-up study, the Spokane group reported a 5.2% early mortality rate and a 12% late mortality rate when revascularization was performed in patients with transmural myocardial infarcts that were less than 24 hours old.5 Similar results have been obtained for nontransmural myocardial infarcts.

In a three-armed study comparing intracoronary streptokinase, percutaneous transluminal angioplasty, and emergency coronary artery bypass grafting, a combined approach to managing the acute