[Immediate bypass operation prevents heart infarct in PTCA emergencies]

Between December 1984 and June 30, 1989, we performed PTCAs on 1438 patients. The procedures were performed with strict cardiosurgical standby. In 24 patients (22 X LAD, 2 X RCA), abrupt coronary occlusion necessitated immediate bypass surgery. In 19 cases, abrupt coronary closure occurred during PTCA in the cath lab; in five patients, during the following 24 h on the intermediate care ward. No patient died. Immediate bypass surgery prevented myocardial infarction (MI) in 79.2% of the cases. None of the 19 patients with abrupt coronary closure in the cath lab had a Q-wave myocardial infarction postoperatively. One of these 19 patients had an R-wave reduction (non-Q-MI) and one patient had a new terminally negative T-wave in the postoperative ECG. Two of the five patients with evidence of acute coronary occlusion on the intermediate care ward had small Q-wave MIs and one had a non-Q-wave MI postoperatively. Time of ischemia (defined als time interval between the end of PTCA and the beginning of extracorporal circulation) was 65 +/- 28 min in the former group and 122 +/- 30 min in the latter.

Because immediate bypass surgery prevents Q-wave MI after abrupt closure during PTCA, strict temporal and spatial cooperation with the cardiac surgeon is mandatory.