title: Time constraints in the emergency coronary bypass surgery for acute evolving myocardial infarction.
abstract: Fourty four patients underwent emergency coronary grafting for evolving myocardial infarction. All patients but one had undergone coronary angiography before the new infarction, 50% were in cardiogenic shock or under cardiopulmonary resuscitation. The mean time interval between the onset symptoms and opening of the bypass to the threatened area was 171 minutes. The operative mortality was 6.8%. At 30 months after surgery, the cardiac actuarial survival was 93.2%, the angina free group 94.2% of the operative survivors. Infarct size and regional ejection fraction of these patients at late follow-up were compared to those of controls treated conventionally for acute infarction. The thallium defects were smaller and the regional ejection fraction of the involved segment was higher after early surgery (less than 3 hours ischemia) than in controls. In the late surgery group the thallium defects and the regional ejection fractions were similar. Ultrastructural studies on biopsy samples taken from the center of the threatened area show reversible changes in the early surgery group but irreversible mitochondrial damage and cell membrane rupture in the late surgery group. Biochemical analysis of similar cardiac biopsies shows recovery after one hour empty beating reperfusion but only in the early surgery group. Our results suggest that coronary surgery can be beneficial to the patient with an evolving myocardial infarction, if the clinical situation does not permit intracoronary thrombolysis. However, one hour reperfusion of the empty beating heart before weaning off bypass is essential. The time constraints for both emergency surgery or thrombolysis are similar.
mesh_terms: D000328:Adult; D000368:Aged; D001157:Arterial Occlusive Diseases / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D001026:Coronary Artery Bypass / Q000401:mortality; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D009206:Myocardium / Q000648:ultrastructure; D010477:Perfusion; D013318:Stroke Volume; D013997:Time Factors