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Emergency coronary artery revascularization: a possible therapy for acute myocardial infarction
Insights
Emergency saphenous vein bypass graft (SVBG) surgery for acute myocardial infarction (MI) can salvage heart muscle and improve patient hemodynamics. This study found low mortality rates, suggesting SVBG is a viable option for evolving MI.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Myocardial infarction (MI) involves progressive cardiac muscle death.
- Revascularization can potentially salvage ischemic myocardium.
Purpose of the Study:
- To evaluate the efficacy and safety of emergency saphenous vein bypass graft (SVBG) surgery in patients with acute myocardial infarction (MI).
Main Methods:
- A preliminary study of 75 patients undergoing emergency SVBG for acute MI.
- Patients were divided into two groups: those requiring hemodynamic support (Group 1) and those who were hemodynamically stable (Group 2).
- Surgical techniques were standard, with an average delay of 6.5 hours from chest pain onset to surgery.
Main Results:
- Group 1 (hemodynamically unstable) had one operative death and two late deaths.
- Group 2 (hemodynamically stable) had no operative deaths.
- Post-surgery, ejection fraction increased by 34%, left ventricular end-diastolic pressure decreased by 40%, and stroke volume improved by 25% in restudied patients.
- Overall operative mortality was 1.3% and late mortality was 2.8%.
Conclusions:
- Emergency SVBG is associated with low mortality and significant hemodynamic improvements in patients with acute MI.
- Cautious further investigation of emergency SVBG for evolving MI is warranted.
Abstract:
Cardiac muscle death caused by coronary artery occlusion is a dynamic process that often takes hours or days. Emergency revascularization (saphenous vein bypass graft (SVBG) during acute myocardial infarction (MI) can interrupt myocardial necrosis, salvage ischemic myocardium and revascularize vessels with obstructive lesions not involved in the MI. In this report we describe a preliminary experimental study of 75 patients in which emergency SVBG was the therapy for acute MI. Group 1, 16 patients, required vasoactive medications and/or intraaortic balloon pumping to maintain their blood pressure preoperatively. There was one operative death and two late deaths. Group 2 consisted of 59 hemodynamically stable patients. There were no deaths. The average preop CPK in group 1 was 892 vs 504 in group 2 (p greater than 0.05). Surgical techniques were routine. The average time from the onset of chest pain that continued to surgery was 6.5 hours. Forty patients were restudied. Post- vs presurgical hemodynamics revealed ejection fraction increased by 34% (p greater than 0.05), left ventricular end-diastolic pressure reduced by 40% (p greater than 0.01). End-systolic and end-diastolic volume reduced by 30% (p greater than 0.05), and 15% (p greater than 0.01), and stroke volume improved 25% (p greater than 0.05). Operative mortality was 1.3% and late mortality 2.8%. These results suggest that cautious continued trial of emergency SVBG in patients with evolving MI is warranted.