Coronary artery bypass for acute myocardial infarction

Coronary artery bypass has been done on 20 patients for acute mmyocardial infarction associated with shock, arrhythmia, and/or cardiac arrest. Twelve had had catheterization before the time of infarction. There were 3 hospital deaths, 2 late deaths, and 15 survivors. Survivors are angina-free and active 4 to 40 months postoperatively. Five patients have been recatheterized since operation, and in 4 all grafts are patent and functioning. Ventricular function was not improved in one patient, has remained the same in one, and improved in 3 patients. Although the time interval from infarction to revascularization is important, success is just as dependent on the patient's existing coronary collateral circulation. Lesions of the left main coronary artery were associated with the highest mortality. The rationale for operation in patients with acute myocardial infarction is to revascularize the marginal myocardium adjacent to the infarct and other underperfused areas when indicated. Chance for survival may thereby be increased by improvement of cardiac pumping or reversal of cardiac arrest or arrhythmia.