Combined medical and surgical procedure in acute myocardial infarction--a preliminary report.

Abstract

The purpose of this investigation was to evaluate a new therapeutic approach, by which acutely ischemic human myocardium could be reperfused. The procedure was as follows: intracoronary application of nitroglycerine, intraluminal recanalization by catheters and intracoronary application of streptokinase. Before and after these interventions coronary angiograms were made. Surgical coronary revascularization was performed 1--64 days after reestablishment of flow through the occluded vessels. Seven patients with acute myocardial infarction were treated in this manner. The mean preoperation ejection fraction was 48.6%, the mean enddiastolic pressure was 17.5 mmHg and the mean maximal CPK activity was 616 units/liter (u/l). By the conservative regimen outlined, reopening of the occluded vessels was achieved in all cases. Critical stenoses of 80--85%, however, persisted. But, reperfusion appeared sufficient since in none of the patients hemorrhagic myocarditis was produced intra-operatively. There was no hospital mortality. The mean post-operative ejection fraction was 60% and the mean enddiastolic pressure was 10.6 mmHg. It is concluded that ischemic myocardium can be reperfused by the active conservative regime tested. Emergency revascularization performed after induced reperfusion appears to carry a low operative risk.