Abstract
Coronary cinearteriography (CAG) has been considered a contraindication in cases of an acute myocardial infarction (AMI) or an unstable angina pectoris (U-AP). However, recently the CAG has been applied to such cases for an emergency examination, not only for determining the size of an obstruction and interfering pathogenesis of an myocardial infarction in an acute stage, but also for treating the obstruction by thrombolysis (PTCR).
We have utilized an emergency CAG in 43 cases which were diagnosed either suffering from an AMI or an U-AP. Then, in 30 cases out of 34 patients diagnosed as having an AMI, we tried PTCR treatment. Coronary recanalization was successfully brought about in 24 cases (80%), and was unsuccessful in 6 cases (20%). Spontaneous recanalization was observed, in 4 patients. In all cases in which PTCR brought about coronary recanalization, we investigated these cases later, when patients were in their chronic stage, by left ventriculography (LVG). In patients who were successfully treated by PTCR or recovered after spontaneous recanalization, we observed no complications following an AMI, such as serious ventricular arrhythmia or congestive heart failure. The progress achieved with these patients was so much better in obvious contrast to another group who received no PTCR theraphy or had an unsuccessful PTCR respons.
In all 9 patients that had an U-AP, we were able to make an early and accurate diagnosis by emergency CAG, and were able to prevent a myocardial infarction from developing. Only one of these 9 patients underwent an emergency A-C bypass graft (CABG) and three were given a semi-emergency CABG, all resulting in good clinical courses, because the surgical treatment could protect them from severe myocardial damage.
We thus conclude that an emergency CABG for patients with an AMI or with an UAP is of great importance. We also emphasize that thrombolysis (PTCR) is an immediate life-saving treatment, and a superior method of theraphy to any mechanical support giving left ventricular assistance or the use of intra- aortic balloon pumping (IABP).
