Objective Evaluation of Bypass Surgery in Patients with Acute Coronary Artery Disease

: 80 patients with acute coronary artery disease, including 70 patients with PIA, 8 patients with acute myocardial infarction, and 2 patients with cardiogenic shock, underwent bypass surgery. The surgical mortality rate was 1.4% in patients with PIA and during an average follow-up period of 15 months none of the patients died of cardiac disease. Ventricular function, as indicated by systolic ejection fraction and segmental wall motion, was noted to improve in many patients. Postoperative studies showed the internal mammary artery to be superior to the saphenous vein graft for left coronary bypass procedures. This was demonstrated by 100% patency of internal mammary artery grafts to the left anterior descending coronary artery. We believe that when a patient presents with one of the syndromes of acute coronary artery disease such as unstable angina, severe chest pain suggestive of infarction without infarction, status anginosis, recurrent ventricular tachycardia or acute myocardial infarction complicated by evidence of potential extension, cardiogenic shock, heart block or rupture, these patients deserve at least coronary and left ventricular cineangiographic studies with hemodynamic evaluation. Our experience to date suggests that myocardial revascularization and catheterization carry a lesser risk than that of medical treatment.