Document Detail

Emergency coronary bypass grafting for evolving myocardial infarction. Effects on infarct size and left ventricular function.
MedLine Citation:
PMID:  3496496     Owner:  NLM     Status:  MEDLINE    
Emergency aorta-coronary bypass grafting was performed early in the course of evolving myocardial infarction in 48 patients. The time interval between the onset of symptoms and reperfusion was 169 +/- 80 minutes. Quantitative assessment of postoperative thallium 201 myocardial scans in 19 patients revealed a significant salvage of myocardium after surgical reperfusion: The size of the residual infarction was less than 50% of that in a matched, medically treated, prospective control group (n = 39) (p less than 0.05). Postoperative equilibrium-gated radionuclide blood pool studies (technetium 99m) showed an enhanced recovery of regional and global ejection fraction after operation as compared to after medical treatment (p less than 0.05). Ultrastructural evaluation of biopsy specimens obtained during the operation delineated subendocardial necrosis in the majority of cases (72%), but subepicardial necrosis was found in only 6% of instances. Q-wave abnormalities were observed on the postoperative electrocardiogram in 50% of cases. Operative mortality was 0% in low-risk patients (i.e., hemodynamically stable condition, n = 26) and 18% in high-risk patients (i.e., cardiogenic shock including total electromechanical dysfunction, n = 22). Survival rate at 18 months was 92% +/- 4%, and 95% +/- 4% of the survivors were event free. It is concluded that early surgical reperfusion of evolving myocardial infarction limits infarct size significantly, enhances functional recovery, and may be a lifesaving operation in patients having cardiogenic shock associated with unsuccessful resuscitation.
W Flameng; P Sergeant; J Vanhaecke; R Suy
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  94     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  1987 Jul 
Date Detail:
Created Date:  1987-08-03     Completed Date:  1987-08-03     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:  124-31     Citation Subset:  AIM; IM    
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MeSH Terms
Actuarial Analysis
Coronary Artery Bypass*
Follow-Up Studies
Heart / radionuclide imaging
Myocardial Infarction / diagnosis,  mortality,  surgery*
Myocardium / pathology
Postoperative Care
Radioisotopes / diagnostic use
Thallium / diagnostic use
Reg. No./Substance:
0/Radioisotopes; 7440-28-0/Thallium

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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