HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Russell M. Nelson Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Anderson, J. L. Articles by Nelson, R. M. Search for Related Content PubMed PubMed Citation Articles by Anderson, J. L. Articles by Nelson, R. M.

Ann Thorac Surg 1986;41:176-183
© 1986 The Society of Thoracic Surgeons

---

Articles

Coronary Bypass Surgery Early after Thrombolytic Therapy for Acute Myocardial Infarction

Department of Surgery, Division of Cardiovascular Surgery, and the Department of Medicine, Division of Cardiology, Latter Day Saints Hospital and University of Utah School of Medicine, Salt Lake City, UT

Accepted for publication April 1, 1985.

^* Address reprint requests to Dr. Anderson, LDS Hospital, 325 8th Ave, Salt Lake City, UT 84143

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 < 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 < 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. The incidence of ventricular and atrial arrhythmias did not differ. The number of days in intensive care (means, 2.3 for the controls and 2.4 for the streptokinase group) and the number of days to discharge (means, 9.4 for the controls versus 9.8 for the streptokinase group) did not differ. A postoperative myocardial infarction occurred in 2.4% of the controls and none of the streptokinase patients. There was 1 hospital death (0.6%) among the controls and none among the streptokinase patients. Although more experience is needed, bypass operations a median of 5 days after the administration of streptokinase for myocardial infarction may be associated with a similar excellent prognosis as routine bypass procedures.