The surgeon's role in the treatment of acute myocardial infarction.
Most acute myocardial infarctions are associated with thrombotic occlusion superimposed on a significant coronary arterial atherosclerotic plaque. Restoration of coronary flow can limit ultimate infarct size if accomplished within 4 to 6 hours of the onset of symptoms. Thrombolytic therapy with intracoronary and intravenous streptokinase or by tissue-specific plasminogen activator is effective as a rapid means of reperfusing infarcting myocardium. Percutaneous coronary angioplasty and surgically constructed bypass grafts can convert a tenuous source of coronary flow to reliable, unrestricted myocardial perfusion. Although acute surgical revascularization can be performed during an evolving infarction, the time restraints imposed by ischemic cellular injury dictate that bypass grafting serve as an adjunct to thrombolytic therapy as a means of preventing rethrombosis and providing global as well as regional revascularization. The vast potential benefit for minimizing morbidity and mortality resulting from quantitative limitation of acute myocardial necrosis mandates scientific evaluation of the new armamentarium directed at medical-surgical reperfusion.
Silverman
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D000800:Angioplasty, Balloon; D001026:Coronary Artery Bypass; D003326:Coronary Circulation; D004630:Emergencies; D006801:Humans; D007430:Intraoperative Care; D009203:Myocardial Infarction / Q000188:drug therapy / Q000601:surgery* / Q000628:therapy; D009204:Myocardial Revascularization; D010477:Perfusion; D010960:Plasminogen Activators / Q000627:therapeutic use; D013300:Streptokinase / Q000627:therapeutic use; D013997:Time Factors
D013300:Streptokinase; D010960:Plasminogen Activators