Coronary artery bypass grafting within 24 hours after intracoronary streptokinase thrombolysis

Abstract

Little specific information currently exists describing the management of patients with an evolving acute myocardial infarction (AMI) treated with direct intracoronary infusion of streptokinase (SK) followed by emergency coronary artery bypass grafting (CABG). A total of 194 patients with an evolving AMI underwent emergency coronary artery angiography with infusion of SK. Thirty-four of these patients with partial restoration of orthograde blood flow in the infarct-related coronary artery (as determined by clinical and objective evidence of myocardial salvage) were referred for emergency CABG. Problems related to the surgical and anesthetic care of these high-risk patients involved: (1) management of resuscitation of patients with AMI, (2) SK-induced coagulopathy and ongoing thrombolysis, and (3) timely CABG to preserve myocardial salvage. To highlight comparisons of SK-CABG management, data regarding 34 consecutive patients having routine non-SK-CABG surgery were collected simultaneously during the study. Data collected retrospectively included: anesthetic drug summaries, time frame of events from admission to the emergency room until commencing bypass, use of invasive monitoring and hemodynamic assist devices, induction complications, operative complications, coagulation derangements, volume replacement, and blood loss. Results revealed no deaths up to 24 hours postoperatively in the 34 emergency SK-CABG patients, even though complications were frequent intraoperatively. Furthermore, there were no statistically significant differences in SK patients v non-SK patients in blood lost, banked blood and cell saver blood administered, or platelet transfusions. However, in comparison to the non-SK-CABG patients, the SK patients received significantly larger amounts of fresh frozen plasma, cryoprecipitate, and aminocaproic acid.