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Bypass surgery following thrombolytic therapy.

The reocclusion rate of infarct vessels following lysis amounted to 61/80 (24%) with a peak during the first week following the acute event. According to Harrison there is a strong correlation between the probability of reocclusion and the diameter of the residual stenosis, while the reocclusion rate is independent from the anti-coagulative regimen. In the presence of preserved myocardial function and significant residual stenoses as well as in patients with multi vessel disease additional PTCA or early bypass surgery seems to be indicated, in order to prevent re-infarction. 55 out of 180 patients following intracoronary lysis, 6 out of 30 following systemic lysis and 2 out of 10 following lysis with TPA were operated upon within one week following the acute event. Hospital mortality was 3.1% (2/63) and late mortality was 1.6% (1/61). Out of 123 bypass grafts 105 (86%) were found to be patent at reangiography. The risk of bleeding was studied in 24 patients who were operated upon within 24 hours following the acute event. Although the clotting factors, especially the serum fibrinogen, had decreased below normal values, there was no increased postoperative blood loss. The coagulation factors had risen to normal values within 24 hours.