Studies of controlled reperfusion after ischemia. XVI. Early recovery of regional wall motion in patients following surgical revascularization after eight hours of acute coronary occlusion

This study tests the hypothesis that failure of 'successful' streptokinase with and without angioplasty to restore regional wall motion in patients with acute coronary occlusion is due to reperfusion injury that can be avoided in the surgical setting by control of the conditions of reperfusion and the composition of the reperfusate. Of 31 consecutive patients undergoing emergency coronary revascularization, 21 patients were reperfused medically with normal blood (streptokinase with or without angioplasty) following 4.5 ± 0.4 hours of coronary occlusion in the coronary catheterization laboratory. Surgical reperfusion in 10 patients was with aspartate-glutamate-enriched blood cardioplegic solution during coronary artery bypass grafting after 8.5 ± 0.5 hours (7.2 to 11.4 hours) of acute coronary occlusion. Hemodynamic instability was present in 5 of 10 surgical patients before operation and resulted from coronary occlusion, whereas 7 to 21 previously stable medical patients became unstable hemodynamically following revascularization with normal blood. Surgical patients evolved fewer electrocardiographically determined infarctions (7/10 versus 21/21, p < 0.05), had fewer reperfusion ventricular arrhythmias (0/10 versus 9/21, p < 0.05), had somewhat better global ejection fractions (47% versus 41%), and had shorter hospitalization times (8.3 versus 10.7 days, p < 0.05); in addition, they all showed significant segmental contractility at discharge (10/10 versus 2/21, p < 0.05), despite delay of revascularization up to 11 hours. No deaths occurred. These studies imply that acute coronary occlusion is treated best by control of the conditions of reperfusion and the composition of the reperfusate.