Urgent surgical reperfusion in acute evolving myocardial infarction. A randomized controlled study

• Published in: Circulation (New York, N.Y.) Vol. 78; no. 3 Pt 2; pp. I171 - I178
• Main Authors: Koshal, A, Beanlands, D S, Davies, R A, Nair, R C, Keon, W J
• Format: Journal Article
• Language: English
• Published: United States 01.09.1988
• Subjects: Clinical Trials as Topic; Coronary Artery Bypass; Coronary Circulation; Emergencies; Female; Humans; Male; Middle Aged; Myocardial Infarction - mortality; Myocardial Infarction - physiopathology; Myocardial Infarction - surgery; Myocardial Infarction - therapy; Radionuclide Angiography; Random Allocation; Stroke Volume
• ISSN: 0009-7322

To assess the benefit of immediate surgical reperfusion over conventional medical treatment during the first acute evolving transmural myocardial infarction, 68 patients presenting within 4 hours of onset of chest pain were randomized into a medical group and a surgical group. Both groups were comparable for age, sex, coronary risk factors, location of infarct, and coronary anatomy. Radionuclide global ejection fraction at 48 hours after admission was 45 +/- 15% for the medical group versus 50 +/- 15% for the surgical group; at 3 months, ejection fraction values were 51 +/- 13% and 51 +/- 13%, respectively (p = NS). The average radionuclide wall-motion scores (normal, 3) at 3 months were 2 +/- 0.6 for the medical group and 2 +/- 0.7 for the surgical group. There were three (8.8%) early and four (11.7%) late deaths in the medical group and only one (2.9%) early death in the surgical group. Urgent surgical reperfusion in acute evolving myocardial infarction is a safe and effective procedure that appears to reduce early and late mortality but does not appear to improve left ventricular function.