Management of acute myocardial ischemia with intraaortic balloon pumping and coronary bypass surgery.
Ninety-three patients with unstable angina pectoris resistant to maximum medical therapy were treated with intraaortic balloon pumping (IABP), early angiography, and myocardial revascularization. Sixty patients had no recent infarction: 42 with typical angina (ST depression > 0.1 mV) and 18 with variant angina (ST elevation > 0.2 mV). Thirty-three patients were post infarction (< 10 days), 25 with typical angina and eight with variant angina. IABP interrupted ischemic attacks in 75/93 (81%) and reduced frequency and intensity of attacks in the remaining patients. Mortality from revascularization was 5/93 (5.4%) with two deaths in the preinfarction group (3.3%) and three deaths in the postinfarction group (9.1%). Incidence of perioperative myocardial infarction was 2.2%. With an average follow-up of 38 months there have been four late deaths (4.5%), three secondary to myocardial infarction, and only one other symptomatic infarction. After operation, 93% have no significant angina, and 70% are fully active. When IABP is used to control recurrent ischemia, patients with refractory angina pectoris can be safely revascularized and have a favorable long-term prognosis.
Levine
F H
FH
Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
Gold
H K
HK
Leinbach
R C
RC
Daggett
W M
WM
Austen
W G
WG
Buckley
M J
MJ
D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000453:epidemiology; D001026:Coronary Artery Bypass / Q000401:mortality / Q000534:rehabilitation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000379:methods* / Q000401:mortality / Q000534:rehabilitation; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000145:classification / Q000401:mortality / Q000601:surgery*; D017202:Myocardial Ischemia / Q000601:surgery; D012008:Recurrence; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome