Angioplasty in severe heart attack. Anesthesia and general management.

BACKGROUND: Percutaneous transluminal coronary angioplasty is more and more widely applied for the treatment of acute coronary syndromes. Both if primary employed or following an unsuccessful thrombolytic treatment (rescue angioplasty), it improves the early and late outcome of acute myocardial infarction patients. Anyway, in about 10% of the cases, it fails and must be followed by a coronary artery bypass graft operation. In this case, the patients reach the operating theater with a risk profile that differs from the usual one due to the higher rate of cardiogenic shock (4.5 vs 0.4%), need for intra-aortic balloon pumping (14 vs 0.8%), use of antiaggregants and heparin.

METHODS: 3,296 patients who underwent coronary artery bypass graft operation over the last two years were analysed.

RESULTS: Despite this, in our population of coronary patients undergone surgical revascularization (3,296 consecutive patients in the last two years), we could not find a worsened outcome in patients being operated after a failed primary percutaneous transluminal coronary angioplasty.

CONCLUSIONS: The role of GPIIb-IIIa inhibitors in determining an excessive postoperative bleeding still remains to be defined, but probably mainly depends on the type of drug, its dose, and the time between its administration and the operation.