Coronary Bypass Surgery Early after Thrombolytic Therapy for Acute Myocardial Infarction

Anderson, Jeffrey L.; Battistessa, Sergio A.; Clayton, Paul D.; Cannon, C.Y.; Askins, Jack C.; Nelson, Russell M.

doi:10.1016/s0003-4975(10)62663-x

Cited by 12 publications

(5 citation statements)

References 23 publications

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“…Zimmern et al (1982) reported that "substantial" coronary collateral blood flow is associated with better ventricular wall motion than is "limited" collateral blood flow. Recently, the practicability of rapid dissolution of intracoronary thrombi in acute myocardial infarction by selective infusion of urokinase or streptokinase was shown by Rentrop et al (1981) and Anderson et al (1986). Feyter et al (1984) and Hiasa et al (1985) reported that cases of intracoronary thrombosis with total occlusion of the LMCA could be salvaged by thrombolytic therapy.…”

Section: Discussionmentioning

confidence: 99%

“…What are the advantages to relatively early bypass grafting after thrombolytic therapy? Answers include the following (Anderson et al 1986); preven tion of the rethrombosis; treatment of post perfusion angina caused by a remaining critical lesion; maintenance of myocardial salvage resulting from reperf usion; pro vision of more adequate blood flow to the infarct zone to allow optimal recovery of function and prevention of infarction due to occlusion of diseased vessels other than the acute infarct vessel. Although more experience is needed, relatively early aorto-coronary bypass grafting after admini stration of urokinase for myocardial in farctions may be associated with as good a prognosis as routine bypass operations.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Coronary bypass surgery after thrombolytic therapy for total occlusion of the left main coronary artery.

Hara¹,

Kosuga²,

Aoyagi³

et al. 1986

Kurume Med. J.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Coronary bypass surgery after thrombolytic therapy for total occlusion of the left main coronary artery.

Hara¹,

Kosuga²,

Aoyagi³

et al. 1986

Kurume Med. J.

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“…Patients that re quire emergency coronary artery bypass grafting in this setting would include those with multivessel disease or single-vessel dis ease, those in whom there is adequate time for reperfusion before the completion of ne crosis, when there is an excellent logistical setup, in whom the intervention modalities have failed, and in whom ischemia persists. Thus, in the early evolving infarct (less than 4 h) if thrombolysis and PTCA have been unsuccessful, surgical therapy may be con sidered [2], This particularly concerns the anterior Q-wave myocardial infarction. A major risk factor for the surgical patients is the thrombolytic state after emergency streptokinase or TPA.…”

Section: Acute Evolving Myocardial Infarctionmentioning

confidence: 99%

Surgical Treatment of Acute Myocardial Infarction

Cohn

1989

Cardiology

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In 1989 the following indications for surgical treatment of acute myocardial infarction are: (1) acute evolving myocardial infarction less than 6 h from onset, in patients in whom percutaneous transluminal coronary angioplasty (PTCA) or streptokinase (SK), depending on the coronary anatomy, has been unsuccessful; if single vessel disease, coronary artery bypass grafting (CABG) is unlikely; if multiple vessel disease, CABG is preferable to SK/PTCA unless a very major ‘culprit’ lesion can be identified with certainty; (2) postinfarction angina hours to days after a transmural myocardial infarction unyielding to maximal medical therapy and in patients with a coronary artery obstruction not amenable to PTCA; (3) occlusion of a coronary artery during cardiac catheterization that cannot be fixed by PTCA and/or SK; (4) occlusion of a coronary artery during PTCA causing hemodynamic obstruction and a threatened myocardium subtended by the obstructed coronary artery; (5) balloon-dependent patients in cardiogenic shock without mechanical defects who have adequate residual left ventricular function as determined by regional wall motion studies; (6) ventricular septal defect secondary to myocardial infarction unless there is terminal organ damage; (7) mitral valve replacement with coronary bypass for acute papillary muscle rupture; (8) semi-emergency cardiac transplantation, either with or without a mechanical bridge to transplant in young individuals (less than 50 years) who have suffered massive destruction of left ventricular myocardium by an acute coronary occlusion with or without recurring ventricular tachyarrhythmias. Ejection fraction in this clinical category is always under 0.20 and usually under 0.15.

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“…Consequently, several different approaches have been suggested to reduce the incidence of rethrombosis. These include (a) the thrombolytic approach, extending the duration of therapy to improve the extent of reperfusion (29); (b) the antithrombotic approach, employing either anticoagulants (27,48) or aspirin (17) or both (1 14); (c) the vasodilator approach utilizing nitroglycerin (83), isosorbide dinitrate (35), or prostaglandin El with its prostacyclinlike action (dilatation and platelet inhibition) (95); and (d) the mechanical or surgical approach, i.e., angioplasty (19,65,94, 1 10) or coronary by-pass surgery (5). At present, the most popular approach has been to combine anticoagulation with early angioplasty, but this may not be the final word.…”

Section: Rethrombosismentioning

confidence: 99%

Thrombolytic Agents for Acute Myocardial Infarction

Sherry

1988

Cardiovascular Drug Reviews

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There are five agents [streptokinase (SK), anisoylated plasminogen-streptokinase complex (APSAC), urokinase (UK), recombinant tissue plasminogen activator (rt-PA), and pro-urokinase (r pro-UK)] that have been under evaluation for the treatment of an acute evolving myocardial infarction. All are either indirect or direct activators of plasminogen; they all convert the latter to the proteolytic enzyme plasmin by cleaving the ATg560-Va1561 bond; and all, when used properly, are effective in dissolving recent thrombi and emboli. Each has advantages and disadvantages, but none have established their superiority over the others as yet. This conclusion, while dependent on incomplete data and subject to change, is based on their comparative effects when administered intravenously in patients with acute evolving myocardial infarctions. STREPTOKINASE (SK)Streptokinase, the bacterial protein that reacts immediately on a one-to-one basis with human plasminogen to form a potent and very efficient plasminogen activator, is the least expensive of the agents. The earlier it is administered after the onset of the symptoms of a myocardial infarction, the higher is the frequency of reperfusion (2, 4,2 1,40, 50,7 1,9 1, 106, 1 1 1, 1 15). During the most critical period, i.e., the first 3 h, a reasonable estimate is 65% (100, 104). Great difficulties exist in accurately establishing the incidence or adequacy of reperfusion associated with the administration of thrombolytic agents intravenously during the first 3 h following symptom onset. The estimate given is based primarily on reperfusion rates observed with post-treatment angiograms only (2, 4, 50, 91, 11 1). Pretreatment angiograms were not done in all but one of these studies since the procedure, when added to the time of amval at the catheterization laboratory following symptom onset, prohibits treatment of the vast majority of patients within the first 3 h. The use of angiography, while currently the best method for measuring perfusion, has serious limitations: in the presence of a pathologic process with ongoing necrosis it does not measure flow rates or its adequacy or the efficacy of the more distal perfusion, and the observations are made at

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Coronary Bypass Surgery Early after Thrombolytic Therapy for Acute Myocardial Infarction

Cited by 12 publications

References 23 publications

Coronary bypass surgery after thrombolytic therapy for total occlusion of the left main coronary artery.

Coronary bypass surgery after thrombolytic therapy for total occlusion of the left main coronary artery.

Surgical Treatment of Acute Myocardial Infarction

Thrombolytic Agents for Acute Myocardial Infarction

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