[Acute myocardial infarction late after coronary artery bypass grafting: angiographic findings and results of an invasive approach].
Patients who have undergone coronary artery bypass grafting may develop acute myocardial infarction late after surgery. It is not exactly known in these patients whether acute infarction is predominantly caused by occlusion of bypass or native vessels. Also, there is no systematic and prospective data available with respect to an invasive, revascularizing therapeutic approach. Therefore, acute coronary angiograms were obtained in 21 consecutive patients with acute infarctions and remote bypass grafting to elucidate mechanisms causing myocardial infarction in these patients, and to assess results of catheter-based recanalization. Infarction was causes by acute graft occlusion in 12/21 patients. Fibrinolysis and/or PTCA of grafts was successful in 6/8 attempts, direct PTCA of a native vessel was effective in 1/2 patients, 1 patient underwent emergency re-CABG, and another patient was treated noninvasively. Occlusion of native, ungrafted vessel caused infarction in 9 patients. Direct PTCA of native vessels was effective in 6/7 of those patients, 1 patient had re-CABG, and another patients was treated non-invasively. Together, catheter-based recanalization was obtained in 13/17 attempts. Thirty-day and 1 year mortality (after discharge) was 5% (1/21 patients) and 12%, respectively. Predischarge ejection fraction was 46%. In conclusion, acute occlusion of bypass grafts is responsible for about half of all cases of myocardial infarction in patients late after surgery. Direct angiography and individually tailored catheter-based recanalization in patients with acute myocardial infarction late after surgery yield promising results.
Waldecker
B
B
Medizinische Klinik I, Zentrum Innere Medizin der Justus-Liebig-Universität, Klinikstr. 36, D-35392 Giessen. Bernd.Waldecker@innere.med.uni-giessen.de
Waas
W
W
Haberbosch
W
W
Voss
R
R
Goedecke
M
M
Tillmanns
H
H
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate; D015912:Thrombolytic Therapy; D016896:Treatment Outcome