Delayed operative intervention in cardiogenic shock after myocardial infarction

In a four-year period, 45 patients underwent counterpulsation for cardiogenic shock following myocardial infarction. Of these patients, 27 underwent angiography. Fifteen of them were not considered to be operative candidates because angiography demonstrated only single-vessel disease or diffuse distal coronary artery disease. Twelve patients were candidates for operation and were divided into three subgroups depending on the time of surgical intervention. One patient (Group 1) deteriorated while on counterpulsation, and underwent urgent angiography and operative intervention within 24 hours of balloon insertion. He is now in New York Heart Association (NYHA) Functional Class I. Group 2 consisted of 7 patients whose condition stabilized with use of the balloon but who could not be weaned. All underwent angiography from 7 to 14 days after insertion of the balloon. One patient died suddenly prior to operation. Six patients underwent coronary bypass from 8 to 21 days after balloon insertion. Five survived and are in NYHA Class II or III. Four patients were able to be weaned after angiography (Group 3). All had triple-vessel disease. Operation was undertaken six to eight weeks after infarction to treat persistent congestive heart failure or angina, or to improve chances of long-term survival. Two patients in this group survived. Our experience demonstrates that delayed intervention is an acceptable alternative to urgent operation.