The Annals of Thoracic Surgery, Vol 35, 70-78, Copyright © 1983 by The Society of Thoracic Surgeons
New developments in medical-surgical treatment of acute myocardial infarction
BJ Messmer, W Merx, J Meyer, P Bardos, C Minale and S Effert
Selective intracoronary thrombolysis with streptokinase was successful in
72 of 84 (86%) patients admitted to the hospital with definitive signs of
acute transmural myocardial infarction due to complete occlusion of either
the left anterior descending coronary artery, the right coronary artery, or
the circumflex artery. The average time between onset of acute symptoms and
medically induced reperfusion was 241 +/- 90 minutes (SD). Reperfusion
resulted in prompt relief of pain, regression of cardiogenic shock, and
normalization of electrocardiograms. Follow-up treatment was either medical
or surgical. The 32 medically treated patients had a high reocclusion rate,
with 6 fatal (19%) and 9 nonfatal (28%) reinfarctions. In order to the
reduce the risk of reinfarction, additional simultaneous transluminal
balloon angioplasty was done in a recent series of patients with stenoses
accessible to this technique. The best early and long-term results were
achieved in 17 patients who underwent coronary artery bypass grafting
within three days after successful thrombolysis. There was no operative
mortality, and subsequent bleeding has not been a problem. It is concluded
that early operation is the treatment of choice in all patients suitable
for such intervention who have undergone successful intracoronary
thrombolysis within 4 hours after onset of acute myocardial infarction.
Late coronary bypass operation should be reserved for symptomatic patients
who have definitive signs of infarction in spite of successful
thrombolysis.
