title: Emergency coronary artery bypass surgery preserves global and regional left ventricular function after intravenous tissue plasminogen activator therapy for acute myocardial infarction.
abstract: Emergency coronary bypass surgery was performed in 24 (6.2%) of 386 consecutive patients enrolled in the Thrombolysis and Angioplasty in Myocardial Infarction (TAMI) Multicenter Trial. Intravenous tissue plasminogen activator was administered 2.6 +/- 0.7 h and bypass surgery was performed 7.3 +/- 1.9 h after the onset of infarction. Infarct artery patency was achieved in 21 (88%) of the 24 patients (pharmacologically in 18 or mechanically with coronary angioplasty in 3) in the catheterization laboratory before bypass surgery. The indication for surgery was left main or equivalent coronary artery disease in 7 patients, coronary anatomy unsuitable for angioplasty in 4 patients and unsuccessful coronary angioplasty in 13 patients. A coronary perfusion catheter was inserted before surgery in 11 of 13 patients with unsuccessful angioplasty. All three deaths occurred postoperatively in patients with preoperative cardiogenic shock. Three patients required surgical reexploration for postoperative hemorrhage. Comparison of preoperative and predischarge contrast left ventriculograms demonstrated significant preservation of global (left ventricular ejection fraction 49 +/- 6 to 56 +/- 6%; p = 0.008) and regional (standard deviation/chord -2.6 +/- 0.5 to -1.5 +/- 1.1; p = 0.001) left ventricular function. Emergency coronary bypass surgery can be performed with a low morbidity and mortality in patients treated with intravenous tissue plasminogen activator therapy for acute myocardial infarction. Such therapy is associated with significant preservation of global and regional (infarct zone) left ventricular function.
authors.affiliation: Christ Hospital, Cincinnati, Ohio.
authors.forename: D J
authors.initials: DJ
authors.lastname: Kereiakes
authors.forename: E J
authors.initials: EJ
authors.lastname: Topol
authors.forename: B S
authors.initials: BS
authors.lastname: George
authors.forename: C W
authors.initials: CW
authors.lastname: Abbottsmith
authors.forename: R S
authors.initials: RS
authors.lastname: Stack
authors.forename: R J
authors.initials: RJ
authors.lastname: Candela
authors.forename: W W
authors.initials: WW
authors.lastname: O'Neill
authors.forename: L H
authors.initials: LH
authors.lastname: Martin
authors.forename: R M
authors.initials: RM
authors.lastname: Califf
mesh_terms: D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass; D003326:Coronary Circulation; D004334:Drug Administration Schedule; D004630:Emergencies; D005069:Evaluation Studies as Topic; D005260:Female; D006352:Heart Ventricles / Q000187:drug effects / Q000503:physiopathology; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence; D013318:Stroke Volume / Q000187:drug effects; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D010959:Tissue Plasminogen Activator