SURGICAL-TREATMENT FOR LIFE-THREATENING ACUTE MYOCARDIAL-INFARCTION -A PROSPECTIVE PROTOCOL

Objective: In this paper we describe the preliminary results of a pros pective operative protocol designed in order to define the role of eme rgent myocardial revascularization in extensive acute miocardial infar ction and in post-infarction cardiogenic shock. Methods: Entry criteri a are: age <75 years; anterior acute myocardial infarction with ST seg ment elevation >4 leads, infero-postero-lateral or inferior and right ventricular, within 6 h from onset of chest pain; post-infarction card iogenic shock within 3 h from onset of shock. From November 1994 to Ju ly 1995, after emergency coronary arteriography, 23 patients were trea ted by coronary artery bypass grafting. Fifteen were operated for exte nsive acute myocardial infarction (group A, mean age 54.1 +/- 9.4 year s) and eight for post-infarction cardiogenic shock (group B mean age 6 5.0 +/- 8.7 years). Mean time from onset was 4.4 +/- 1.3 h in group A and 2.2 +/- 0.8 h in group B. Mean left ventricular ejection fraction was 39.3 +/- 12.7% in group A and 22.6 +/- 3.5% in group B. Six out of eight group B patients needed intraaortic balloon counterpulsation pr eoperatively, and 2/8 cardiopulmonary resuscitation. Results: Myocardi al revascularization consisted in 3.4 +/- 1.1 grafts in group A (vein grafts, except for 8 patients who also received a left internal thorac ic artery graft) and 3.3 +/- 1.1 vein grafts in group B. All patients in group B and 3/15 (20%) in group A underwent intraaortic balloon cou nterpulsation. In-hospital death occurred in 1/15 (6.7%) patients of g roup A and in 4/8 (50%) patients of group B. At a mean follow-up of 4. 1 +/- 3.3 months for group A and of 3.9 +/- 2.2 months for group B lef t ventricular ejection fraction was 43.4 +/- 9.0% in group A and 35.7 +/- 13.1% in group B. Conclusions: Experience of 9 months with this pr ospective protocol showed its effectiveness in the management of criti cally ill patients with acute coronary occlusion leading to low mortal ity rate in acute myocardial infarction and improved survival rate in post-infarction cardiogenic shock. (C) 1997 Elsevier Science B.V.