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[Clinical results and modification of left ventricular function after emergency revascularization for acute
V Paolillo1, G Ottino, A De Berardinis
1Divisione di Cardiologia, Ospedale San Giovanni di Torino.
Insights
Emergency revascularization for myocardial infarction within six hours of symptom onset significantly improves left ventricular function. Early surgery in evolving myocardial infarction patients enhances recovery and survival rates.
Area of Science:
- Cardiology
- Cardiac Surgery
- Emergency Medicine
Context:
- Evolving myocardial infarction requires timely intervention to preserve cardiac function.
- Emergency revascularization aims to restore blood flow to ischemic heart muscle.
- Assessing the impact of surgical timing on outcomes is crucial for patient management.
Purpose:
- To evaluate the effectiveness of emergency revascularization in patients with evolving myocardial infarction.
- To determine the influence of the time interval from symptom onset to surgery on cardiac function and survival.
- To identify patient subgroups that benefit most from early surgical intervention.
Summary:
- A study of 43 patients undergoing emergency revascularization for myocardial infarction between 1985 and 1988 showed an overall hospital mortality of 6.9%.
- Patients operated on within six hours of symptom onset demonstrated significant improvements in left ventricular ejection fraction (p < 0.005) and regional ejection fraction (p < 0.0005).
- Conversely, patients operated on after six hours showed a decrease in both left ventricular and regional ejection fractions, indicating less favorable outcomes.
Impact:
- Early emergency revascularization, particularly within six hours, can lead to improved left ventricular performance in selected myocardial infarction patients.
- These findings support the benefit of prompt surgical intervention in managing evolving myocardial infarction.
- The study highlights the importance of time-sensitive treatment strategies in improving cardiac recovery and long-term survival.
Abstract:
Results of emergency revascularization for evolving myocardial infarction have been evaluated in 43 consecutive patients operated between January 1985 and March 1988. Time interval between onset of symptoms and coronary bypass averaged 6.7 +/- 0.5 hours (0.75-48). Intravenous or intracoronary thrombolysis was attempted pre-operatively in 26 cases. Overall hospital mortality was 6.9% (3/43) but this decreased to only 2.7% if patients in cardiogenic shock were excluded. Follow-up averaged 20.6 +/- 9.5 months (4-42). Actuarial survival was 82.9 +/- 7.3% at 36 months. Of the 36 survivors, 28 were free from angina and reinfarction at control. Nineteen patients were evaluated with angiography at follow-up (averaging 10.1 +/- 5.7 months). Left ventricular and regional ejection fraction were calculated on pre- and post-operative angiograms; regional ejection fraction was determined with the centerline method. Left ventricular ejection fraction increased from 0.49 +/- 0.15 to 0.52 +/- 0.19 (NS), regional ejection fraction improved from 0.20 +/- 0.1 to 0.27 +/- 0.16 (35% increment, p less than 0.05). The analysis of left ventricular and regional ejection fraction variations with the time elapsed from the onset of symptoms to surgery identified two subgroups of patients: those operated within and after six hours. In the first subgroup, left ventricular ejection fraction increased from 0.52 +/- 0.16 to 0.62 +/- 0.13 (p less than 0.005) and regional ejection fraction from 0.19 +/- 0.08 to 0.36 +/- 0.14 (89% increment, p less than 0.0005). In the second subgroup, both left ventricular and regional ejection fractions decreased from 0.44 +/- 0.13 to 0.36 +/- 0.11 (NS) and from 0.20 +/- 0.13 to 0.12 +/- 0.08 (NS), respectively. These results lead to the conclusion that improved left ventricular performance may be achieved in selected groups of patients if they undergo surgery within six hours of the onset of pain.