Surgical management for acute coronary insufficiency with three year's follow-up.

In this report, acute coronary sufficiency is defined as unstable angina requiring narcotics for relief and an unstable electrocardiogram with or without transient mild enzyme elevations. Forty-five consecutive patients with this syndrome underwent coronary artery grafting with the saphenous vein within 48 hours of the onset of symptoms. They were followed for 3 years. There was an 8.8 per cent operative mortality rate. One long-term survivor sustained a fatal myocardial infarction 18 months postoperatively. One nonfatal myocardial infarction occurred 6 weeks postoperatively. Therefore, the 3 year cumulative mortality rate was 11 per cent and the 3 year myocardial infarction rate was 4 per cent. Thirty-eight patients are in Class I clinical status, 1 is in Class II, and 1 is in Class III.