Rubio Pedro A., Guinn Gene A.
The Cora and Webb Mading Department of Surgery, Baylor College of Medicine, and Veterans Administration Hospital, Houston, Texas.
Cardiovasc Dis. 1975;2(4):402-404.
Myocardial infarction has been the major cause of mortality following operation for cerebrovascular insufficiency. In our institution, a clinical diagnosis of coronary artery disease was made in 37 of 125 (29.6%) consecutive male patients having carotid endarterectomy. Six of these 37 patients developed postoperative myocardial infarction. In contrast, none of the 88 patients without coronary artery disease developed myocardial infarction. A more recently treated group of 20 patients who had undergone carotid artery surgery and had previously undergone coronary artery bypass for angina did not develop postoperative myocardial infarction. These data suggest that in patients with both coronary artery and carotid artery disease, prior or concomitant coronary artery bypass should be considered. Myocardial infarction has been the leading cause of early and late death following operation for cerebrovascular insufficiency.(1) DeBakey(2) found operative mortality in patients having surgery for cerebrovascular insufficiency directly related to the incidence of coronary artery disease. An increased operative mortality due to reinfarction has been found in patients recovering from recent myocardial infarction.(3) Cooley(4) found that in patients having aortocoronary bypass there was no increased operative mortality 30 days after myocardial infarction and this may apply to patients having carotid endarterectomy. Subendocardial postoperative infarction associated with minor T wave changes and slight enzyme elevation had a better prognosis than did transmural infarction causing significant Q waves, sequential ST and T wave changes and marked enzyme elevations.(5) The purpose of this study was to document our experience with myocardial infarction in patients undergoing carotid artery operation for clinical coronary artery disease. Consideration of the role of saphenous vein bypass in those patients with coronary artery disease was the background for this review even though the evidence that myocardial infarction can be prevented with saphenous vein bypass operation is only preliminary at the present time.(6)
心肌梗死一直是脑血管功能不全手术后死亡的主要原因。在我们机构，125例连续接受颈动脉内膜切除术的男性患者中，有37例（29.6%）被临床诊断为冠状动脉疾病。这37例患者中有6例术后发生心肌梗死。相比之下，88例无冠状动脉疾病的患者均未发生心肌梗死。另一组最近接受治疗的20例患者，曾因心绞痛接受冠状动脉搭桥术，之后又接受了颈动脉手术，术后未发生心肌梗死。这些数据表明，对于同时患有冠状动脉疾病和颈动脉疾病的患者，应考虑先行或同期进行冠状动脉搭桥术。心肌梗死一直是脑血管功能不全手术后早期和晚期死亡的主要原因。（1）德贝基（2）发现，脑血管功能不全手术患者的手术死亡率与冠状动脉疾病的发生率直接相关。近期心肌梗死康复患者因再梗死导致手术死亡率增加。（3）库利（4）发现，在接受主动脉冠状动脉搭桥术的患者中，心肌梗死后30天手术死亡率并未增加，这可能适用于接受颈动脉内膜切除术的患者。与轻微T波改变和轻微酶升高相关的心内膜下术后梗死，其预后优于导致明显Q波、连续ST段和T波改变以及显著酶升高的透壁梗死。（5）本研究的目的是记录我们在临床诊断为冠状动脉疾病且接受颈动脉手术患者中，关于心肌梗死的经验。尽管目前大隐静脉搭桥术可预防心肌梗死的证据仅为初步，但考虑大隐静脉搭桥术在这些冠状动脉疾病患者中的作用是本综述的背景。（6）
