Coronary Reperfusion: Medical, Surgical, or Not at All? FREE

K. Lance Gould, MD

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JAMA. 1982;248(11):1362-1363. doi:10.1001/jama.1982.03330110058031

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ABSTRACT

ABSTRACT | REFERENCES

In this issue of The Journal (p 1325), Phillips et al report improved ventricular function and survival in patients undergoing immediate bypass surgery for acute myocardial infarction, findings similar to their earlier observations in 1979.¹ Berg² and DeWood et al³ from Spokane, Wash, initially reported improved survival in patients who had undergone coronary bypass surgery as compared with medically treated patients with acute myocardial infarction. These articles demonstrate both the promise and the problems of innovative, aggressive intervention to reperfuse jeopardized myocardium, demonstrated by most,^4-7 but not all,^8-10 experimental studies to be beneficial.

On the positive side, Phillips et al have set aside arbitrary assumptions about a fixed, maximum duration of chest pain beyond which salvage is considered infeasible. Their decision for surgical intervention depended on clinical evidence of ongoing ischemia that indicated remaining viable myocardium as compared with depending on rigid time periods based

REFERENCES

ABSTRACT | REFERENCES

Phillips SJ, Kongtaworn C, Zeff RH, et al: Emergency coronary artery revascularization: A possible therapy for acute myocardial infarction . Circulation 1979;;60:241-246.

Berg R: Acute myocardial infarction treated as a surgical disease , in Heiss HW (ed): Advances in Clinical Cardiology . New York, Gerhard Witzstrock Publishing House, 1980;, pp 629-645.

DeWood MA, Spores J, Notske RN, et al: Medical and surgical management of myocardial infarction . Am J Cardiol 1979;;44:1356-1364.

Costantini C, Corday E, Lang TW, et al: Revascularization after three hours of coronary arterial occlusion: Effects on regional cardiac metabolic function and infarct size . Am J Cardiol 1975;;36:368-384.

Bolooki H, Kotler MD, Lottenberg L, et al: Myocardial revascularization after acute infarction . Am J Cardiol 1975;;36:395-406.

Theroux P, Ross J, Franklin D, et al: Coronary arterial reperfusion: III. Early and late effects on regional myocardial function and dimensions in conscious dogs . Am J Cardiol 1976;;38:599-606.

Baughman KL, Maroko PR, Vatner SF: Effects of coronary artery reperfusion on myocardial infarct size and survival in conscious dogs . Circulation 1981;;63:317-323.

Lang TW, Corday E, Gold H, et al: Consequences of reperfusion after coronary occlusion . Am J Cardiol 1974;;33:69-86.

Bresnahan GF, Roberts R, Shell WE, et al: Deleterious effects due to hemorrhage after myocardial reperfusion . Am J Cardiol 1974;;33:82-86.

Bana VS, Chadda KD, Helfant RH: Limitations of myocardial revascularization in restoration of regional contraction abnormalities produced by coronary occlusion . Am J Cardiol 1974;;34:164-170.

Rentrop KP, Blanke H, Karsch KR: Effects of nonsurgical coronary reperfusion on the left ventricle in human subjects compared with conventional treatment . Am J Cardiol 1982;;49:1-8.

Ganz W, Buchbinder N, Marcus H, et al: Intracoronary thrombolysis in evolving myocardial infarction . Am Heart J J 1981;;101:4-13.

Reduto LA, Smalling RW, Freund GC, et al: Intracoronary infusion of streptokinase in patients with acute myocardial infarction: Effects of reperfusion on left ventricular performance . Am J Cardiol 1981;;48:403-409.

Reduto LA, Freund GC, Gaeta JM, et al: Coronary artery reperfusion in acute myocardial infarction: Beneficial effects of intracoronary streptokinase on left ventricular salvage and performance . Am Heart J 1981;;102:1168-1177.

May GS, Chir B, DeMets DL, et al: The randomized clinical trial: Bias in analysis . Circulation 1981;;64:669-673.

Fletcher AP. Alkjaersig N, Smyrniotis FE, et al: The treatment of patients suffering from early myocardial infarction with massive and prolonged streptokinase therapy . Trans Assoc Am Physicians 1958;;71:287.

Fletcher AP, Sherry S, Alkjaersig N, et al: The maintenance of a sustained thrombolytic state in man: II. Clinical observations on patients with myocardial infarction and other thromboembolic disorders . J Clin Invest 1959;;38:1111.

Sherry S: Personal reflections on the development of thrombolytic therapy and its application to acute coronary thrombosis . Am Heart J 1981;;102:1134-1139.

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