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Emergency revascularization for unstable angina
Insights
Emergency revascularization for unstable angina may salvage myocardium but risks perioperative infarction. Some patients already had myocardial infarction before surgery, suggesting a need for ischemia management before definitive treatment.
Area of Science:
- Cardiology
- Vascular Surgery
Background:
- Unstable angina requires prompt intervention.
- Defining optimal timing for revascularization in unstable angina is crucial.
Purpose of the Study:
- To evaluate the outcomes of emergency revascularization in patients with unstable angina.
- To assess the safety and efficacy of immediate surgical intervention.
Main Methods:
- 100 consecutive patients with unstable angina underwent emergency revascularization.
- Patient data included vessel disease severity and left main trunk obstruction.
- Follow-up included clinical assessment and postoperative angiography.
Main Results:
- 4 operative deaths (3 from myocardial infarction) occurred.
- 18% of early survivors sustained perioperative infarction.
- Mean graft patency was 86% at 14 months, with 72% of survivors symptom-free at 42 months.
Conclusions:
- Emergency revascularization can salvage myocardium but carries risks of perioperative infarction.
- In some cases, myocardial infarction may precede surgery, indicating a need for ischemia management and diagnostic evaluation first.
Abstract:
Emergency revascularization for unstable angina (defined according to criteria of the National Cooperative Study Group) was performed in 100 consecutive patients. The mean interval from onset of pain to operation was one day. Nineteen patients had single-vessel narrowing of greater than 70% of lumen diameter, 32 double-vessel obstruction and 49 triple-vessel disease. Fourteen of these patients had left main trunk obstruction. Four patients died within 30 days, three from complications of myocardial infarction. Seventeen of 96 (18%) early survivors sustained perioperative infarction. After a mean follow-up of 42 months, four late deaths and three late infarctions occurred. Postoperative angiography in 47 patients (mean interval 14 months) showed 86% graft patency. Of 92 survivors, 72 are symptom-free. Three of the four operative deaths occurred within 24 hours postoperatively; in each of these, postmortem examination confirmed a recent myocardial infarction which antedated the operation, despite the absence of new infarction in the peroperative electrocardiogram or elevation of cardiac enzymes. Results from this emergency series suggest that, although myocardium may be salvaged in some instances, in other cases infarction has already occurred and treatment might better be directed toward alleviation of acute ischemia to provide a stable period in which diagnostic studies are performed and acute myocardial infarction may be ruled out.