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Circulation, Vol 60, 5-9, Copyright © 1979 by American Heart Association

ARTICLES

Safe early revascularization for continuing ischemia after acute myocardial infarction

FH Levine, HK Gold, RC Leinbach, WM Daggett, WG Austen and MJ Buckley

Early revascularization following myocardial infarction (MI) is reported to have a high risk of extension of and hemorrhage into infarction with resulting high mortality and morbidity. To evaluate this issue, 80 post-MI patients (aged 32-74 years) with unstable angina pectoris resistant to maximal medical therapy were reviewed. All patients underwent early uncomplicated angiography and subsequent revascularization; 55 (69%) were less than 10 days post-MI, and 25 (31%) were 10-30 days post-MI. Intraaortic balloon pumping was required in 72% for relief of intractable angina or hemodynamic instability. Of the 80 patients, 19% had single vessel disease (VD), 31% double VD, and 50% triple VD. The mortality rate from coronary bypass surgery was 7/80 (8.8%), with four cardiac and three noncardiac deaths. Two patients suffered a perioperative MI (2.5%). At a mean follow-up period of 33 months, there had been only one late death and one recurrent nonfatal MI; 96% of the patients had no significant angina. In patients with continuing ischemia immediately after MI, myocardial revascularization can be safely performed without further injury to the myocardium, and with excellent long-term results.

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