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Early bypass grafting following intracoronary thrombolysis with streptokinase
Insights
Early bypass grafting after intracoronary streptokinase infusion is safe and effective for acute coronary thrombosis patients. This approach improved left ventricular ejection fraction, showing comparable risks to elective surgery.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Acute coronary artery thrombosis and severe coronary disease necessitate timely interventions.
- Intracoronary streptokinase has shown potential in restoring blood flow to infarcting myocardium.
Purpose of the Study:
- To evaluate the safety and efficacy of early bypass grafting after intracoronary streptokinase in patients with acute myocardial infarction.
- To assess the impact on left ventricular ejection fraction and operative risks.
Main Methods:
- Prospective study of 41 patients with acute myocardial infarction.
- Emergency cardiac catheterization and intracoronary streptokinase administration within 18 hours of chest pain onset.
- Coronary artery bypass grafting (CABG) performed 3-10 days post-thrombolysis.
- Serial gated radionuclide left ventricular angiograms to determine ejection fraction (EF) at admission, preoperatively, and at 3-6 months follow-up.
Main Results:
- 34 patients (88%) had complete arterial occlusion; reperfusion was unsuccessful in 30 (88%).
- 32 patients (78%) had multivessel disease; an average of 2.8 grafts per patient were placed.
- Operative mortality was 2% (one patient).
- In 23 patients with admission EF < 50%, EF significantly increased from 33% +/- 11% to 41% +/- 9% preoperatively (p < 0.001) and persisted at follow-up (40% +/- 14%).
Conclusions:
- Early bypass grafting following intracoronary streptokinase is associated with a low operative risk.
- This strategy leads to significant improvement in left ventricular ejection fraction in patients with reduced baseline EF.
- The risk of bypass grafting within 3-10 days of intracoronary streptokinase appears similar to elective surgery remote from infarction.
Abstract:
Early bypass grafting following intracoronary thrombolysis with streptokinase may be indicated in patients with acute coronary artery thrombosis and severe coronary disease. To evaluate this approach, we prospectively studied 41 patients (32 men and nine women, mean age 53 years) with acute infarction. Emergency cardiac catheterization was performed within 18 hours after onset of chest pain and intracoronary streptokinase was given. All patients underwent bypass 3 to 10 days later (mean 7 days). Serial gated radionuclide left ventricular angiograms to determine ejection fraction were obtained on hospital admission, preoperatively, and 3 to 6 months later. Thirty-four patients had complete occlusion of the artery supplying the infarcted segment. In 30 patients (88%) reperfusion was not successful. In seven patients the artery was not totally thrombosed. Thirty-two patients (78%) had multivessel disease. An average of 2.8 grafts per patient were placed with an operative mortality of 2% (one patient). Serial measurements of ejection fraction were obtained in 23 patients in whom the admission ejection fraction was less than 50%. There was a significant increase in ejection fraction from admission (33% +/- 11%) to the preoperative measurement (41% +/- 9%, p less than 0.001), and this improvement persisted at follow-up (40% +/- 14%). Intracoronary streptokinase has been shown to restore blood flow to infarcting myocardium and to improve left ventricular performance. In patients with significant organic stenosis, the risk of bypass grafting 3 to 10 days after intracoronary streptokinase infusion appears to be no different from the risk of elective operation performed at a time remote from an acute infarction.