Early operative intervention for complications of acute myocardial infarction.

Cardiac operations were performed on 21 patients for treatment of complications of acute myocardial infarction unresponsive to vigorous drug therapy. There were six hospital deaths (28.5 per cent) and 15 survivors 3 to 50 months postoperatively. Fourteen of the 15 survivors are asymptomatic (Class I N.Y.H.A.); one patient remains in Class III. The average time from infarction to operation was 7 days; operative mortality rate was unrelated to the time from infarction to operation. Five of six deaths were in patients with preoperative cardiogenic shock who were not supported by an external cardiac assistance device. The two survivors of cardiogenic shock, treated preoperatively with the intraaortic balloon pump (IABP), are now asymptomatic. Early operative intervention is recommended to decrease the mortality rate in patients with complications of acute myocardial infarction unresponsive to conventional medical therapy. Preoperative treatment with the IABP is advised for the patient in cardiogenic shock.