Emergency surgical reperfusion in evolving myocardial infarction

The purpose of our study was to determine the benefits and the safety of early surgical revascularization in acute evolving myocardial infarction. Twenty-four patients underwent, during the last two years, such a procedure at our institution: 3 patients had acute evolving myocardial infarction, 3 others were after thrombolysis with intracoronary streptokinase and 18 patients were after percutaneous transluminal coronary angioplasty. The patients underwent the surgery at an average of less than 5 hours from the beginning of chest pains; 21 patients were males, the average age of the whole group being 53 years. The average number of diseased coronary arteries per patient was 1.6; 3 of the patients had previous myocardial infarction. Forty-four grafts were inserted - 1.8 per patient. No severe complications were observed, 1 patient died postoperatively (sudden death). Seven patients had post surgery angiography which showed an overall graft patency rate of 86 percent, in 6 patients left ventricular function was normal, improved or unchanged. Early surgical revascularization in patients with acute evolving myocardial infarction can be performed effectively with a very low morbidity and mortality and with a positive effect on coronary circulation and cardiac function.