Long-term follow-up in patients receiving emergency revascularization for intermediate coronary syndrome

Abstract

From 1969 to 1973, 42 patients were treated with emergency myocardial revascularization for intermediate coronary syndrome (ICS). Clinically, these patients presented with angina pectoris associated with temporary electrocardiographic (ECG) changes (Group I); persistent ECG evidence of subendocardial ischemia (Group 11), or early myocardial infarction (Group III). After a period of 4 to 7 days of conservative management, hemodynamic and cardiac catheterization studies were done because of persistence of chest pain. These studies were followed within a few hours by myocardial revascularization. There were no operative deaths, but 6 patients (14 per cent) developed intraoperative myocardial infarcts. Two other patients had developed transmural infarction after angiography. At restudy, both had a large left ventricular aneurysm in spite of patent coronary grafts. Twenty-four patients had follow-up cardiac catheterization between 1 and 24 months postoperatively, and 95 per cent of them had patent vein grafts. Twenty patients have been followed an average of 3 years (range 2 to 4 years). None has developed myocardial infarcts, and all are asymptomatic, except for 1 patient who was operated 8 hours after an acute infarct. These results indicate favorable early and long-term benefits in patients receiving emergency myocardial revascularization for ICS unresponsive to medical management.