SUPERIORITY OF CONTROLLED SURGICAL REPERFUSION VERSUS PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY IN ACUTE CORONARY-OCCLUSION

Although percutaneous transluminal coronary angioplasty is successful in more than 90% of patients after acute coronary occlusion, overall m ortality remains approximately 10% with higher subgroup mortality (i.e ., occlusion of the left anterior descending coronary artery, multives sel disease, age older than 70 years, cardiogenic shock) and early rec overy of regional wall motion is marginal. This multicenter report sho ws that controlled surgical reperfusion in patients with acute coronar y occlusion reduces overall and subgroup mortality and restores substa ntial early contractility. In a survey from six institutions, 156 cons ecutive patients with acute coronary occlusion documented by angiograp hy underwent surgical revascularization with controlled reperfusion us ing amino acid-enriched blood cardioplegic solution on total vented by pass. Ventricular wall motion was studied by echocardiography or multi ple gated acquisition scan on postoperative days 5 to 7 and scored ind ependently (0 = normal, 1 = mild hypokinesia, 2 = severe hypokinesia, 3 = akinesia, 4 = dyskinesia). Results are compared with results in 12 03 patients with acute coronary occlusion treated by angioplasty in fi ve reported medical series. Surgically treated patients were revascula rized at longer ischemic intervals (6.3 versus 3.9 hours, p < 0.05) an d had a greater incidence of left anterior descending occlusion (61% v ersus 43%, p < 0.05), multivessel disease (42% versus 22%, p < 0.05), and cardiogenic shock (41% versus 10%, p < 0.05), with 12 patients und ergoing cardiopulmonary resuscitation en route to the operating room. Surgical results were superior in all categories, with overall mortali ty reduced from 8.7% after angioplasty to 3.9% after coronary bypass ( p < 0.05). All surgical deaths occurred in patients with preoperative cardiogenic shock. Regional wall motion recovered significantly (score < 2) in 131 of 150 (87%) surgically treated patients with an average score of 0.9 +/- 0.8 (normal to mild hypokinesia) despite longer ische mic times.