[Early revascularization after acute myocardial infarction]

Coronary artery bypass grafting (CABG) was performed on 40 consecutive patients within the first month after acute myocardial infarction (AMI) between January 1985 and July 1988. Group I (N = 27) included patients with unstable postinfarction angina who underwent operation within 16 +/- 14 days after infarction. Group II (N = 13) underwent emergency operation after failed percutaneous transluminal coronary angioplasty (PTCA) which was complicated by AMI. This group was operated on within 4.5 +/- 3 hours after onset of symptoms. There was left ventricular dysfunction (ejection fraction less than .35) in 8 Group I patients. Ventricular function of Group II patients during and after infarction could not be evaluated. The internal thoracic (mammary) artery (ITA) was used in 26 patients. Early mortality was 2.5% (1 patient). Preoperative low cardiac output (LCO) was associated with increased need for inotropic and intra-aortic balloon pump support during termination of cardiopulmonary bypass (p less than 0.02), and it predicted postoperative LCO (p less than 0.03). Preoperative reduced ventricular function was associated with increased need for inotropic support, LCO, and ventricular arrhythmias (p less than 0.02, p less than 0.05, p less than 0.02, respectively). The postoperative course was complicated by LCO in 71% of those with saphenous vein grafts, but in only 30% of those with ITA grafts (p less than 0.02). Inotropic and mechanical support needed during weaning from cardiopulmonary bypass was significantly less in those with the ITA graft (p less than 0.05, p less than 0.03, respectively). Hospital stay after surgery was 12 +/- 7 and 9 +/- 2 days for Groups I and II, respectively (NS).(ABSTRACT TRUNCATED AT 250 WORDS)