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Chest, Vol 91, 648-653, Copyright © 1987 by American College of Chest Physicians

ARTICLES

Early percutaneous transluminal coronary angioplasty or coronary bypass surgery following thrombolytic treatment of acute myocardial infarction

BI Salem, S Gowda, M Haikal, R Leidenfrost, JL Cox and T Ferguson

Coronary reocclusion rates following intracoronary streptokinase (IC- SK) infusion remain significantly high despite anticoagulation. Early intervention by coronary angioplasty (PTCA) or coronary bypass surgery (CABG) was advocated to minimize such risk and/or maintain coronary reperfusion. Of 71 consecutive patients (60 men, 11 women; mean age, 54.9 years) who underwent IC-SK infusion for acute myocardial infarction (MI) 50 had early CABG, 18 had PTCA, and three had both procedures. Sixty-four of the 71 had successful thrombolysis. Thirty- six patients had either CABG or PTCA within three days, 22 patients within seven days, and 13 patients within two weeks. There was no immediate or in-hospital mortality, and all patients remained alive through the follow-up period of three to 36 months. Functional class (FC) 1 was achieved in 45 patients, FC 2 in 22 patients, FC 3 in three patients, and FC 4 in one patient. Sixty-seven patients (94 percent) were free of chest pain through the follow-up period. These data suggest that early intervention by CABG and/or PTCA in suitable candidates could be achieved with reduced risk and expected to yield favorable results. This favorable trend could be related to maintenance of myocardial perfusion by these procedures, initially induced by thrombolysis. Long-term, large-scale studies are needed to confirm the role of optimal timing of such procedures, but we believe that such results indicate that early revascularization yields promising results.


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I. K. Toumpoulis, C. E. Anagnostopoulos, D. G. Katritsis, J. J. DeRose Jr, and D. G. Swistel
The Impact of Preoperative Thrombolysis on Long-Term Survival After Coronary Artery Bypass Grafting
Circulation, August 30, 2005; 112(9_suppl): I-351 - I-357.
[Abstract] [Full Text] [PDF]


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Copyright © 1987 by the American College of Chest Physicians.