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[Acute coronary syndrome].
Kyobu Geka. 2004 Jul; 57(8 Suppl):663-70.KG

Abstract

The first choice of interventional treatment for acute coronary syndrome is percutaneous coronary intervention (PCI), especially when the patient is in cardiogenic shock. In cases of acute myocardial infarction, emergency coronary artery bypass grafting (CABG) is indicated when left main trunk (LMT) lesion or severe triple-vessel disease is left after PCI combined with residual or recurrent ischemic angina and/or ST-T change in electrocardiogram (ECG). Similarly, in cases of unstable angina, emergency CABG is indicated when LMT or LMT equivalent (proximal left anterior descending branch and left circumflex branch) is the culprit lesion or when severe triple-vessel disease exists. Urgency of operation and existence of cardiogenic shock are major operative risk factors of CABG in patients with acute coronary syndrome. The surgical mortality of such cases is much higher than that of elective surgery for chronic angina. As employment of cardiopulmonary bypass (CPB) and achievement of cardioplegic arrest is one of the major causes of surgical mortality, off-pump CABG (OPCAB) using no CPB nor cardioplegic solution has recently become popular. OPCAB, however, is difficult to perform when the hemodynamic state is unstable. On-pump beating heart CABG is an alternative technique of choice because it not only stabilizes the hemodynamic state but also prevents myocardial ischemia/reperfusion injury. These beating heart CABG techniques will improve surgical outcome of acute coronary syndrome.

Authors+Show Affiliations

Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.

Pub Type(s)

English Abstract
Journal Article

Language

jpn

PubMed ID

15362542

Citation

Makuuchi, Haruo. "[Acute Coronary Syndrome]." Kyobu Geka. the Japanese Journal of Thoracic Surgery, vol. 57, no. 8 Suppl, 2004, pp. 663-70.
Makuuchi H. [Acute coronary syndrome]. Kyobu Geka. 2004;57(8 Suppl):663-70.
Makuuchi, H. (2004). [Acute coronary syndrome]. Kyobu Geka. the Japanese Journal of Thoracic Surgery, 57(8 Suppl), 663-70.
Makuuchi H. [Acute Coronary Syndrome]. Kyobu Geka. 2004;57(8 Suppl):663-70. PubMed PMID: 15362542.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Acute coronary syndrome]. A1 - Makuuchi,Haruo, PY - 2004/9/15/pubmed PY - 2004/10/6/medline PY - 2004/9/15/entrez SP - 663 EP - 70 JF - Kyobu geka. The Japanese journal of thoracic surgery JO - Kyobu Geka VL - 57 IS - 8 Suppl N2 - The first choice of interventional treatment for acute coronary syndrome is percutaneous coronary intervention (PCI), especially when the patient is in cardiogenic shock. In cases of acute myocardial infarction, emergency coronary artery bypass grafting (CABG) is indicated when left main trunk (LMT) lesion or severe triple-vessel disease is left after PCI combined with residual or recurrent ischemic angina and/or ST-T change in electrocardiogram (ECG). Similarly, in cases of unstable angina, emergency CABG is indicated when LMT or LMT equivalent (proximal left anterior descending branch and left circumflex branch) is the culprit lesion or when severe triple-vessel disease exists. Urgency of operation and existence of cardiogenic shock are major operative risk factors of CABG in patients with acute coronary syndrome. The surgical mortality of such cases is much higher than that of elective surgery for chronic angina. As employment of cardiopulmonary bypass (CPB) and achievement of cardioplegic arrest is one of the major causes of surgical mortality, off-pump CABG (OPCAB) using no CPB nor cardioplegic solution has recently become popular. OPCAB, however, is difficult to perform when the hemodynamic state is unstable. On-pump beating heart CABG is an alternative technique of choice because it not only stabilizes the hemodynamic state but also prevents myocardial ischemia/reperfusion injury. These beating heart CABG techniques will improve surgical outcome of acute coronary syndrome. SN - 0021-5252 UR - https://www.unboundmedicine.com/medline/citation/15362542/[Acute_coronary_syndrome]_ L2 - https://medlineplus.gov/heartattack.html DB - PRIME DP - Unbound Medicine ER -