[Iatrogenic myocardial infarction]

In this paper, iatrogenic myocardial infarction resulting from percutaneous catheter intervention (PCI) and cardiac surgery is described. Among the patients who had experienced iatrogenic myocardial infarction in the past 4 years, 6 had undergone emergent coronary artery bypass grafting (CABG). An emergent operation for myocardial infarction was performed on 3 patients, for problems associated with PCI, and 1 patient had died due to cardiac failure. In the latter case, although the emergent CABG was performed after the failure of percutaneous coronary intervention in another hospital, no improvement in cardiac function was observed. The reason for this was that the myocardial damage became almost irreversible due to the delay in transferring the patient to our hospital. An additional CABG was performed in 2 cases, because they experienced a cardiogenic shock after cessation of the cardio-pulmonary bypass system. In these cases, cardiac function had improved immediately after an additional CABG. Some ST elevation in the electrocardiograms was observed in 8 cases in the intensive care unit after isolated CABG. One patient experienced a cardiogenic shock, and was transferred to the operating room immediately. The radial artery graft connected in sequence to circumflex coronary arteries was spastic, and an additional bypass was performed to the same coronary arteries using a saphenous vein graft. Although conservative medical therapy was administered in the remaining 7 cases, 1 case presented an occlusion of the left descending coronary artery, and an emergent CABG should have been performed. ST elevations in 2 cases were caused by coronary spasm, while in the remaining 4 cases, they were caused by pericardiotomy. Although a postoperative change in the electrocardiogram was considered important, the diagnosis was complicated. In myocardial infarction, cardiogenic shock develops easily, and an emergent CABG is needed in many cases. It is important to decide on an emergent operation promptly after an accurate diagnosis.