Management of acute myocardial ischemia with intraaortic balloon pumping and coronary bypass surgery.

Ninety-three patients with unstable angina pectoris resistant to maximum medical therapy were treated with intraaortic balloon pumping (IABP), early angiography, and myocardial revascularization. Sixty patients had no recent infarction: 42 with typical angina (ST depression > 0.1 mV) and 18 with variant angina (ST elevation > 0.2 mV). Thirty-three patients were post infarction (< 10 days), 25 with typical angina and eight with variant angina. IABP interrupted ischemic attacks in 75/93 (81%) and reduced frequency and intensity of attacks in the remaining patients. Mortality from revascularization was 5/93 (5.4%) with two deaths in the preinfarction group (3.3%) and three deaths in the postinfarction group (9.1%). Incidence of perioperative myocardial infarction was 2.2%. With an average follow-up of 38 months there have been four late deaths (4.5%), three secondary to myocardial infarction, and only one other symptomatic infarction. After operation, 93% have no significant angina, and 70% are fully active. When IABP is used to control recurrent ischemia, patients with refractory angina pectoris can be safely revascularized and have a favorable long-term prognosis.