Coronary artery surgery and direct coronary artery thrombolysis during acute myocardial infarction.

Twelve patients underwent direct coronary artery streptokinase thrombolysis during acute evolving myocardial infarction. Ten patients had restoration of orthograde pulmonary blood flow. Eight patients had significant myocardial salvage and clinical stabilization. Nine patients had subsequent coronary artery bypass surgery with no major hematological or cardiac complications. Five of these had surgery performed immediately. Two patients with no myocardial salvage after streptokinase had urgent surgery because of other critical coronary lesions. Seven patients with thrombolytic salvage of myocardium underwent urgent coronary artery bypass surgery without incident. The occurrence of two reinfarctions in streptokinase-improved patients waiting for surgery suggests that delay is unwarranted and coronary bypass surgery is needed to insure success.