Safe early revascularization for continuing ischemia after acute myocardial infarction.
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.
D000328:Adult; D000368:Aged; D000787:Angina Pectoris; D001026:Coronary Artery Bypass / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control; D011183:Postoperative Complications / Q000401:mortality; D012050:Rehabilitation, Vocational; D012501:Saphenous Vein; D013997:Time Factors; D014182:Transplantation, Autologous; D014680:Veins / Q000637:transplantation*