Mechanism of acute myocardial infarction in patients with prior coronary artery bypass grafting and therapeutic implications

Cindy L. Grines, David C. Booth, Steven E. Nissen, John C. Gurley, Kim A. Bennett, William N. O'Connor, Anthony N. DeMaria

Research output: Contribution to journalArticlepeer-review

76 Scopus citations

Abstract

Although acute myocardial infarction (AMI) is usually due to thrombotic occlusion when involving a native coronary artery, the mechanism responsible for AMI in patients with previous coronary artery bypass grafting (CABG) is not well understood. Since knowledge of pathophysiology of AMI may alter subsequent management, anglograms obtained between 1 hour and 7 days of AMI (median 1 day) were reviewed in 50 patients > 1 year after CABG. The culprit vessel was identified by the presence of residual stenosis and/or thrombus in the vessel supplying the infarct zone or by reviewing previous anglograms. The infarct vessel was identified as a vein graft in 38 (76%) patients, the native vessel in 8 patients (16%) and could not be accurately determined in 4 patients (8%). Among the 38 vein grafts suspected as the infarct vessel, unequivocal angiographic evidence of residual thrombus (filling defect/persistent staining) was present in 31 (82%) and was >2 cm in length in 15 patients. Successful reperfusion occurred in only 2 of 8 (25%) grafts after intravenous thrombolytic therapy. Intragraft thrombolysis with or without additional angioplasty was successful at restoring flow in 8 of 10 (80%) grafts. Data indicate that in patients who have undergone previous CABG, AMI is usually caused by thrombotic occlusion of a saphenous vein graft and that conventional intravenous thrombolytic therapy may be inadequate to restore flow. The large mass of thrombus and absent flow in the graft may require subselective drug infusion, a higher thrombolytic dose or a mechanical means of recanalization.

Original languageEnglish
Pages (from-to)1292-1296
Number of pages5
JournalAmerican Journal of Cardiology
Volume65
Issue number20
DOIs
StatePublished - Jun 1 1990

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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