| Autor: |
Wiener, Leslie, Walinsky, Paul, Kasparian, Hratch, Duca, Peter R., Gottlieb, Ronald S., Hanckel, Frances, Templeton, John Y., Brest, Albert N. |
| Zdroj: |
Journal of Thoracic and Cardiovascular Surgery; April 1978, Vol. 75 Issue: 4 p612-620, 9p |
| Abstrakt: |
Cardiac angiography has had limited success in predicting the potential for salvage of jeopardized ischemic myocardium. In this context, we have examined the effect of coronary sinus pacing on myocardial lactate extraction in order to determine its predictive role. All 159 patients with unstable angina or acute myocardial infarction were found angiographically suited for coronary bypass surgery. In addition, myocardial lactate extraction was assessed prior to, during, and after coronary sinus pacing. Conventional medical treatment was carried out in 72 patients, whereas 87 patients were treated with coronary bypass surgery. Therapy was determined on clinical and angiographic grounds, independent of myocardial lactate extraction. In medically treated unstable angina, patients with a myocardial lactate production (MLP) of greater than 15 percent showed an in-hospital mortality rate of 21.4 percent; no deaths were observed in those with less than 15 percent MLP (p < 0.05). Similarly, in patients with acute myocardial infarction, greater than 15 percent MLP identified a high-risk subset (33.3 percent mortality >15 percent MLP versus 0 percent mortality <15 percent MLP, p < 0.05). Without benefit of subgrouping by myocardial lactate analysis, the results of surgical treatment in patients considered candidates for emergency myocardial revascularization were not significantly different from those in patients treated medically. However, surgery favorably altered mortality (11.5 percent surgical mortality versus 26.9 percent medical mortality, p < 0.05) in those patients identified by a greater than 15 percent MLP response to coronary sinus pacing. Hence, among presumably high-risk coronary patients treated medically, myocardial lactate analysis was useful in predicting clinical outcome. In addition, myocardial lactate analysis provided a basis for selection of a subset of patients with acute coronary disease in whom emergency myocardial revascularization was of definite value. |
| Databáze: |
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