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Coronary artery bypass grafting within 24 hours after intracoronary streptokinase thrombolysis

A M Mantia1, D M Lolley, E H Stullken

  • 1Department of Anesthesiology, Western Pennsylvania Hospital, Pittsburgh 15224.

Journal of Cardiothoracic Anesthesia
|October 1, 1987
PubMed

Insights

Management of acute myocardial infarction (AMI) with streptokinase (SK) infusion followed by emergency coronary artery bypass grafting (CABG) is feasible, with no early deaths observed. This high-risk procedure requires careful management of SK-induced coagulopathy and timely intervention.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Anesthesiology

Background:

  • Limited data exists on managing acute myocardial infarction (AMI) patients undergoing direct intracoronary streptokinase (SK) infusion followed by emergency coronary artery bypass grafting (CABG).
  • These patients present high surgical and anesthetic risks due to evolving AMI and thrombolytic therapy.

Purpose of the Study:

  • To describe the management and outcomes of patients undergoing emergency CABG after intracoronary SK infusion for evolving AMI.
  • To compare the perioperative care and outcomes of SK-treated CABG patients with those undergoing routine non-SK CABG.

Main Methods:

  • Retrospective analysis of 34 high-risk patients who received emergency CABG after intracoronary SK infusion for AMI.
  • Comparison with 34 consecutive patients undergoing routine non-SK CABG surgery.
  • Data collection included anesthetic management, timing of interventions, hemodynamic support, complications, coagulation status, and blood product usage.

Main Results:

  • No in-hospital deaths occurred within 24 hours postoperatively in the 34 emergency SK-CABG patients, despite frequent intraoperative complications.
  • No significant differences were found in blood loss or blood product administration (banked blood, cell saver, platelets) between SK and non-SK CABG groups.
  • SK-CABG patients received significantly greater amounts of fresh frozen plasma, cryoprecipitate, and aminocaproic acid compared to the non-SK group.

Conclusions:

  • Emergency CABG following intracoronary SK infusion for evolving AMI is a viable, albeit complex, strategy with acceptable early outcomes.
  • Careful management of SK-induced coagulopathy and timely surgical intervention are crucial for myocardial salvage in these patients.
  • While SK-treated patients required more specific blood products to manage coagulopathy, overall perioperative outcomes were comparable to non-SK CABG patients.

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