Jones R N, Pifarré R, Sullivan H J, Montoya A, Bakhos M, Grieco J G, Foy B K, Wyatt J
Ann Thorac Surg. 1987 Aug;44(2):159-63. doi: 10.1016/s0003-4975(10)62030-9.
In 1983 and 1984, coronary artery bypass grafting (CABG) was performed on 107 consecutive patients for postinfarction angina. In each instance, CABG was done within 30 days of infarction. Sixty-three patients (59%) required intravenous administration of nitroglycerin and/or the intraaortic balloon pump (IABP) for relief of angina. Oral medications relieved angina in the remaining 44 patients. Thirty-eight patients underwent CABG 7 days or less after the infarction (Group 1), 25 received it between 8 and 15 days later (Group 2), and 44 had CABG between 16 and 30 days later (Group 3). There were 9 in-hospital deaths: 4 in Group 1, 2 in Group 2, and 3 in Group 3. Thirteen patients needed the IABP for hemodynamic stability as well as relief of angina. Even when the patient was stable hemodynamically, death was more likely to occur among these 13 patients if CABG was conducted within 7 days of infarction. Follow-up was 94% complete at 29.4 months. Eighty-six percent of patients were asymptomatic or in New York Heart Association Functional Class I, and 6% were in Class II. There were 2 late deaths. CABG for angina can be accomplished within 30 days of an acute infarction with good results. The exception to this rule is the patient in whom shock develops after a myocardial infarction and who, despite stabilization, receives CABG within 7 days of the infarction.
1983年和1984年，连续107例心肌梗死后心绞痛患者接受了冠状动脉旁路移植术（CABG）。在每种情况下，CABG均在梗死30天内进行。63例患者（59%）需要静脉注射硝酸甘油和/或主动脉内球囊反搏（IABP）以缓解心绞痛。其余44例患者通过口服药物缓解了心绞痛。38例患者在梗死后7天或更短时间内接受了CABG（第1组），25例在8至15天后接受了CABG（第2组），44例在16至30天后接受了CABG（第3组）。住院死亡9例：第1组4例，第2组2例，第3组3例。13例患者需要IABP以维持血流动力学稳定并缓解心绞痛。即使患者血流动力学稳定，如果在梗死7天内进行CABG，这13例患者中死亡的可能性更大。随访在29.4个月时完成率为94%。86%的患者无症状或处于纽约心脏协会心功能I级，6%处于II级。有2例晚期死亡。急性梗死后30天内进行CABG治疗心绞痛可取得良好效果。这条规则的例外情况是心肌梗死后发生休克的患者，尽管病情稳定，但在梗死7天内接受了CABG。
