Coronary bypass operation for early postinfarction angina

A consecutive series of 38 patients who were hospitalized in the CCU for acute myocardial infarction and who had early postinfarction angina develop were operated upon on an emergency basis within two weeks after the initial infarction. The average time for the reapperance of angina was 1.7 days. Ten patients had reinfarction which occurred on an average of 3.2 days after the reappearance of the angina. Cardiogenic shock occurred in six patients between one to six days after the angina recurred. Three of these patients had severe mitral insufficiency that required mitral valve replacement in addition to the coronary bypass operation. Delay in evaluating these patients angiographically led to complications requiring the use of the intra-aortic balloon pump in 12 patients. The mean time for the angiographic evaluation was 6.8 days after the angina had recurred and the average time for surgical intervention was 1.2 days. The operative mortality in the patients undergoing coronary angiography and surgical treatment within 24 hours after the reappearance of angina (15 patients) was zero per cent; however, when this was delayed up to 48 hours (12 patients), the mortality increased to 8.3 per cent (one patient) and if the angiographic evaluation was delayed over 48 hours after the patient became symptomatic, the operative mortality rose substantially to 27.2 per cent (three patients). Most of the delay in obtaining angiocardiographic evaluation was caused by the attempt to use additional drug therapy or the introduction of new drugs, most of them calcium-blocking agents (nifedipine). It is our belief that physicians caring for patients who have recurrent angina after acute myocardial infarction should be aware that they represent a high risk group that should be studied angiographically promptly to determine operability in order to avoid a high rate of complications and death.