The Annals of Thoracic Surgery, Vol 41, 176-183, Copyright © 1986 by The Society of Thoracic Surgeons
Coronary bypass surgery early after thrombolytic therapy for acute myocardial infarction
JL Anderson, SA Battistessa, PD Clayton, CY Cannon 3d, JC Askins and RM Nelson
The safety of coronary bypass operations after coronary reperfusion with
streptokinase for acute myocardial infarction is not well documented.
Therefore we studied 23 consecutive patients (mean age, 59.5 years; 22 men)
undergoing bypass operations a median of 5 days (range, 1 to 23 days) after
thrombolysis (streptokinase). The control group consisted of 169 concurrent
patients of similar mean age (58.8 years) having bypass operations for
standard indications. The preoperative angiographic ejection fraction was
68 +/- 14% in the control patients and 61 +/- 14% in the streptokinase
group (p less than 0.05). The number of diseased vessels (70% stenosis or
greater) averaged 2.6 in control and 2.3 in streptokinase patients. A
previous myocardial infarction had occurred in 42% of the controls and all
of the streptokinase patients. Aortic cross-clamp times did not differ
between the two groups (80 +/- 35 minutes for the controls and 68 +/- 25
minutes for the streptokinase group). Cardiopulmonary bypass times were
similar: 108 +/- 45 minutes in the controls versus 109 +/- 28 minutes in
the streptokinase group. Grafts per patient averaged 3.7 +/- 1.5 for the
controls versus 2.8 +/- 1.1 for the streptokinase patients (p less than
0.01). Difficult operative hemostasis was noted in 4% of both groups.
Inotropic support was given postoperatively to 11% of the control and 13%
of the streptokinase patients (p = not significant). Measured blood loss
during the first 48 hours postoperatively was similar, averaging 809 ml in
controls and 776 ml in the streptokinase group. Blood product replacement
was also comparable: mean, 713 ml in the control group versus 759 ml in the
streptokinase group.(ABSTRACT TRUNCATED AT 250 WORDS)
