Emergency Coronary Artery Bypass Grafts in the Treatment of Myocardial Infarction
Of the more than 1,900 patients undergoing coronary artery bypass procedures for coronary artery disease, a selected group of 17 patients underwent emergency coronary artery bypass because of the tentative diagnosis of acute myocardial infarction. Almost all patients had status angina prior to cardiac catheterization as was proven by electrocardiographic evidence and serum enzyme changes. When further verification was obtained by gross examination at surgery and autopsy in the patients who expired, most patients had severe end stage coronary artery disease manifested by functional classification and severe anatomical lesions. Cardiac catheterization was done in all patients prior to myocardial infarction. Because of the combination of pre-existing severe anatomical disease and status angina, coronary artery bypass surgery was done despite the presence of acute myocardial infarction in the three groups of patients. Group I consisted of patients with myocardial infarction without hypotension but persistent chest pain and clinical symptoms. Group II patients had similar findings plus hypotension. Group III patients experienced actual cardiac arrest and were resuscitated by portable femoral arteriovenous cardiopulmonary bypass. In group I three of eight patients died, in group II one of six patients, and in group III two of three patients. There were two late deaths at two and three months postoperatively. Operation in the face of acute myocardial infarction has been successfully employed in a selected group of patients.
- © 1973 American Heart Association, Inc.