Retained graft patency after revascularization lowers risk of subseque
nt myocardial infarction or death. Patients who have surgical rather t
han medical therapy are far less Likely to die of a subsequent nonperi
operative infarction. Both myocardial infarction size and lethality ar
e modified by prior coronary artery bypass grafting, The procedure ris
k for either death or nonfatal infarction remains higher in coronary a
rtery bypass grafting than in angioplasty, but among patients who surv
ive for 30 days, subsequent risk is only two-thirds that of patients w
ho had angioplasty. Better graft patency rates are associated with the
use of an internal thoracic artery rather than a saphenous vein, larg
er size of the recipient coronary artery, and better blood flow throug
h the grafts. Aspirin therapy clearly decreases the occlusion rate per
distal anastomosis, but aprotinin therapy arrears to have little or n
o effect on graft patency, Numerous other factors can influence graft
patency. Prominent among the factors increasing risk for requirement o
f a reoperation are nonuse of an internal thoracic artery, incomplete
revascularization, and continued cigarette smoking.