Document Detail

Early bypass grafting following intracoronary thrombolysis with streptokinase.
MedLine Citation:
PMID:  6608636     Owner:  NLM     Status:  MEDLINE    
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.
R P Sterling; W E Walker; A P Weiland; G C Freund; F Fuentes; R W Smalling; K L Gould
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  87     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  1984 Apr 
Date Detail:
Created Date:  1984-05-04     Completed Date:  1984-05-04     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  487-92     Citation Subset:  AIM; IM    
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MeSH Terms
Combined Modality Therapy
Coronary Artery Bypass*
Coronary Disease / therapy*
Coronary Vessels
Heart / radionuclide imaging
Infusions, Intra-Arterial
Middle Aged
Myocardial Infarction / diagnosis
Prospective Studies
Streptokinase / administration & dosage,  therapeutic use*
Stroke Volume
Time Factors
Reg. No./Substance:
EC 3.4.-/Streptokinase

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