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

Excerpt

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