Circulation, Vol 60, 241-246, Copyright © 1979 by American Heart Association
SJ Phillips, C Kongtahworn, RH Zeff, M Benson, L Iannone, T Brown and DF Gordon
Cardiac muscle death caused by coronary artery occlusion is a dynamic
process that often takes hours or days. Emergency revascularization
(saphenous vein bypass graft (SVBG) during acute myocardial infarction (MI)
can interrupt myocardial necrosis, salvage ischemic myocardium and
revascularize vessels with obstructive lesions not involved in the MI. In
this report we describe a preliminary experimental study of 75 patients in
which emergency SVBG was the therapy for acute MI. Group 1, 16 patients,
required vasoactive medications and/or intraaortic balloon pumping to
maintain their blood pressure preoperatively. There was one operative death
and two late deaths. Group 2 consisted of 59 hemodynamically stable
patients. There were no deaths. The average preop CPK in group 1 was 892 vs
504 in group 2 (p greater than 0.05). Surgical techniques were routine. The
average time from the onset of chest pain that continued to surgery was 6.5
hours. Forty patients were restudied. Post- vs presurgical hemodynamics
revealed ejection fraction increased by 34% (p greater than 0.05), left
ventricular end-diastolic pressure reduced by 40% (p greater than 0.01).
End-systolic and end- diastolic volume reduced by 30% (p greater than
0.05), and 15% (p greater than 0.01), and stroke volume improved 25% (p
greater than 0.05). Operative mortality was 1.3% and late mortality 2.8%.
These results suggest that cautious continued trial of emergency SVBG in
patients with evolving MI is warranted.
ARTICLES
Emergency coronary artery revascularization: a possible therapy for acute myocardial infarction
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