[Emergent coronary artery bypass grafting within twenty-four hours following acute myocardial infarction]

We experienced 43 patients with acute myocardial infarction who underwent emergent coronary artery bypass grafting within twenty-four hours from the onset. Twenty-six patients (group S) were in cardiogenic shock preoperatively and fourteen patients of this group had total or subtotal obstruction of the left main trunk. Fourteen of the other seventeen patients (group N) had a left main trunk disease. More patients underwent PTCA and the time required for reperfusion of the infarction-related coronary artery with PTCA was shorter in group S than group N. Preoperative hemodynamics improved in twenty patients in group S. The time required for completion of a coronary artery bypass to the infarction-related coronary artery was also shorter in group S. The operative mortality was 15% in group S and 6% in group N. One noncardiac late death occurred in group S. The postoperative segmental wall motion score of the infarcted left ventricle was much improved in patients with subtotal occlusion of the infarction-related coronary artery. Thus, preoperative hemodynamic improvement by early reperfusion leads to satisfying operative results and salvage of the infarcted myocardium.