Early Myocardial Revascularization during Acute Myocardial Infarction

¹ Cleveland Clinic Foundation, Department of Thoracic and Cardiovascular Surgery, Department of Cardiovascular Disease and the Cardiac Laboratory, Cleveland

Coronary artery surgery was undertaken in 37 patients with acute myocardial infarction. Two-thirds of the group experienced infarction after catheterization but during hospitalization. Coronary arteriography showed severe anterior descending obstruction in 87 percent and multiple vessel disease in 83 percent. Cardiogenic shock developed in six patients preoperatively, four of whom had severe obstruction in the left main coronary artery. Thirty-four of 37 patients were operated on within six hours of the onset of symptoms. Fifteen patients received single bypass grafts, and multiple autografts were constructed in the remaining patients. Five patients (14 percent) died postoperatively, four of whom were in shock before the operation. One operative and one late death occurred in 31 patients with stable vital signs preoperatively. Of the surviving patients followed an average of 19 months after surgery, 25 had no angina pectoris and are considered functional class I(NYHA). Postoperative arteriography performed an average of nine months after surgery revealed a 90 percent patency rate for 29 grafts in 17 patients. The conclusions reached from this experience are: (1) Early revascularization greatly influences the outcome of operations performed during an evolving infarction. (2) Postoperative arteriograms indicated that surgical treatment accomplished a reversal of the peri-infarction ischemia and thus prevented extension of myocardial necrosis. (3) When pathologic arterial anatomy was technically favorable, poor ventricular contraction was not a contraindication to emergency revascularization. (4) Infarcion during hospitalization was a prerequisite for the timing factor involved in these specific cases.

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