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Revascularization after thrombolytic therapy for acute myocardial infarction: an analysis of 573 patients
J A Petrovich1, H A Wellons, J A Schneider
1Prairie Cardiovascular Center, Springfield, IL.
Insights
For acute myocardial infarction, coronary artery bypass grafting (CABG) and percutaneous coronary angioplasty (PTCA) are safe revascularization options. Emergency CABG after failed PTCA carries a high procedural risk.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Acute myocardial infarction (AMI) requires timely reperfusion therapy.
- Revascularization strategies include medical management, coronary artery bypass grafting (CABG), and percutaneous coronary angioplasty (PTCA).
Purpose of the Study:
- To compare the safety and effectiveness of CABG and PTCA in patients with AMI.
- To evaluate the outcomes of emergency CABG following failed PTCA.
Main Methods:
- Retrospective analysis of 891 patients treated with streptokinase for AMI between October 1981 and January 1987.
- Patients were categorized into medical management, CABG alone, or PTCA alone groups.
- Outcomes including procedure mortality were compared between groups.
Main Results:
- Multiple-vessel coronary artery disease was more prevalent in CABG patients (70.3%) than PTCA patients (24.1%).
- Procedure mortality rates were 3.6% for CABG, 5.4% for PTCA, and 13.5% for PTCA with subsequent CABG (p<0.05 vs. CABG alone).
- All deaths in the PTCA with subsequent CABG group occurred in emergent cases (5/20 patients).
Conclusions:
- Both CABG and PTCA are safe and effective revascularization methods for AMI with appropriate patient selection.
- Emergency coronary artery bypass grafting following failed percutaneous coronary angioplasty is associated with significantly higher procedural risk.
Abstract:
From October, 1981, to January, 1987, at our center, 891 patients received streptokinase within 6 hours of acute myocardial infarction. A total of 318 patients were treated medically, while 388 patients (43.5%) underwent coronary artery bypass grafting (CABG) alone and 185 (20.7%) were treated with percutaneous coronary angioplasty (PTCA). Subsequent CABG was performed in 37 of 185 PTCA patients after unsuccessful angioplasty. Group characteristics were similar. However, multiple-vessel coronary artery disease was present in 70.3% of CABG patients compared with 24.1% in the PTCA groups. Procedure mortality was 3.6% for CABG alone, 5.4% for PTCA alone, and 13.5% for the combined angioplasty and operation group (p less than 0.05 compared with CABG). All deaths in the PTCA group with subsequent CABG occurred in those patients taken emergently to CABG (5 of 20 patients). We conclude that with proper patient selection both forms of revascularization are safe and effective. However, emergency coronary bypass surgery in the event of failed angioplasty has a high risk.