Emergency coronary artery bypass surgery preserves global and regional left ventricular function after intravenous tissue plasminogeh activator therapy for acute myocardial infarction

Dean J. Kereiakes, Eric J. Topol, Barry S. George, Charles W. Abbottsmith, Richard S. Stack, Richard J. Candela, William W. O'Neill, Linda H. Martin, Robert M. Califf

Research output: Contribution to journalArticle

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Abstract

Emergency coronary bypass surgery was performed in 24 (6.2%) of 386 consecutive patients enrolled in the Thrombolysis and Angioplasty in Myocardial Infarction (TAMI) Multicenter Trial. Intravenous tissue plasminogen activator was administered 2.6 ± 0.7 h and bypass surgery was performed 7.3 ± 1.9 h after the onset of infarction. Infarct artery patency was achieved in 21 (88%) of the 24 patients (pharmacologically in 18 or mechanically with coronary angioplasty in 3) in the catheterization laboratory before bypass surgery. The indication for surgery was left main or equivalent coronary artery disease in 7 patients, coronary anatomy unsuitable for angioplasty in 4 patients and unsuccessful coronary angioplasty in 13 patients. A coronary perfusion catheter was inserted before surgery in 11 of 13 patients with unsuccessful angioplasty. All three deaths occurred postoperatively in patients with preoperative cardiogenic shock. Three patients required surgical reexploration for postoperative hemorrhage. Comparison of preoperative and predischarge contrast left ventriculograms demonstrated significant preservation of global (left ventricular ejection fraction 49 ± 6 to 56 ± 6%; p = 0.008) and regional (standard deviation/chord -2.6 ± 0.5 to -1.5 ± 1.1: p = 0.001) left ventricular function. Emergency coronary bypass surgery tan he performed with a low morbidity and mortality in patients treated with intravenous tissue plasminogen activator therapy for acute myocardial infarction. Such therapy is associated with significant preservation of global and regional (infarct zene) left ventricular function.

Original languageEnglish
Pages (from-to)899-907
Number of pages9
JournalJournal of the American College of Cardiology
Volume11
Issue number5
DOIs
StatePublished - Jan 1 1988
Externally publishedYes

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Left Ventricular Function
Coronary Artery Bypass
Emergencies
Myocardial Infarction
Angioplasty
Therapeutics
Tissue Plasminogen Activator
Postoperative Hemorrhage
Cardiogenic Shock
Catheterization
Stroke Volume
Infarction
Multicenter Studies
Coronary Artery Disease
Anatomy
Catheters
Arteries
Perfusion
Morbidity
Mortality

ASJC Scopus subject areas

  • Nursing(all)

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Emergency coronary artery bypass surgery preserves global and regional left ventricular function after intravenous tissue plasminogeh activator therapy for acute myocardial infarction. / Kereiakes, Dean J.; Topol, Eric J.; George, Barry S.; Abbottsmith, Charles W.; Stack, Richard S.; Candela, Richard J.; O'Neill, William W.; Martin, Linda H.; Califf, Robert M.

In: Journal of the American College of Cardiology, Vol. 11, No. 5, 01.01.1988, p. 899-907.

Research output: Contribution to journalArticle

Kereiakes, Dean J. ; Topol, Eric J. ; George, Barry S. ; Abbottsmith, Charles W. ; Stack, Richard S. ; Candela, Richard J. ; O'Neill, William W. ; Martin, Linda H. ; Califf, Robert M. / Emergency coronary artery bypass surgery preserves global and regional left ventricular function after intravenous tissue plasminogeh activator therapy for acute myocardial infarction. In: Journal of the American College of Cardiology. 1988 ; Vol. 11, No. 5. pp. 899-907.
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