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Coronary artery bypass surgery following thrombolytic therapy for acute coronary thrombosis
Insights
Coronary bypass surgery after thrombolytic therapy for myocardial infarction is safe. Patients experienced minimal complications, good recovery, and a high return-to-work rate.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Acute myocardial infarction (MI) is a leading cause of mortality.
- Thrombolytic therapy is a primary treatment for acute MI.
- The role of subsequent coronary bypass surgery requires further investigation.
Purpose of the Study:
- To evaluate the safety and efficacy of coronary bypass surgery following thrombolytic therapy for acute myocardial infarction.
- To assess postoperative outcomes, including complications and return-to-work rates.
Main Methods:
- Retrospective analysis of 136 patients undergoing thrombolytic therapy for acute MI.
- 51 patients subsequently underwent coronary bypass surgery (2 hours to 90 days post-thrombolysis).
- Data collected on vessel disease severity, ejection fraction, grafts, operative outcomes, and follow-up.
Main Results:
- No operative deaths occurred in the 51 patients who underwent bypass surgery.
- Postoperative hemorrhagic complications were minimal and comparable to standard bypass surgery.
- Follow-up (2-18 months) showed no severe angina or graft occlusion in treated vessels.
- 89% of eligible patients returned to work.
Conclusions:
- Coronary artery bypass grafting after thrombolytic infusion for acute myocardial infarction is a safe procedure.
- Complete recovery and a high return-to-work ratio can be expected.
- This approach offers a viable option for myocardial revascularization in selected MI patients.
Abstract:
One hundred thirty-six patients underwent thrombolytic therapy for acute evolving myocardial infarction from June, 1981, through December, 1982. Of these patients, 51 underwent coronary bypass procedures from two hours to 90 days (average, 16 days) following thrombolytic therapy. Six (12%) had single-vessel disease, 15 (29%) had double-vessel disease, and 30 (59%) had triple-vessel involvement. Ejection fraction values ranged from 21 to 60%. The average number of grafts performed per patient was 3.4. There were no operative deaths in this series. Postoperative hemorrhagic problems were minimal, and the incidences were no different from those for other coronary bypass patients. In follow-up ranging from 2 to 18 months, there was no recurrence of severe angina or other clinical evidence of saphenous graft occlusion in the thrombolysed vessels. Of the 45 patients eligible to return to work, 40 (89%) have done so. The data from this series suggest that surgical myocardial revascularization after intracoronary thrombolytic infusion for acute myocardial infarction can be performed safely and that complete recovery and a high return-to-work ratio can be anticipated.