Immediate versus delayed coronary grafting after streptokinase treatment. XXXX and clinical results.

@entity1 @entity190 @entity1003 @entity260 @entity177 @entity86 @entity583 @entity1455 @entity204
Of all @entity1 with acute evolving @entity583 treated surgically at Duke University Medical Center between 1984 and 1986, 27 @entity1 given high doses (greater than 1.5 million units) of streptokinase preoperatively were studied. Eleven @entity1 who received streptokinase had coronary bypass grafting 12 hours after thrombolytic therapy (early hours), eight @entity1 between 12 and 72 hours (delayed), and eight @entity1 beyond 72 hours (late hours). Seventeen @entity1 who underwent coronary bypass grafting within 6 hours of the onset of symptoms, without preoperative streptokinase, were included as control @entity1 . Only the @entity1 having early operation had significantly greater postoperative @entity190 ; postoperative use of red blood cells; fresh-frozen plasma; cryoprecipitate; prolonged postoperative prothrombin time; and prolonged partial thromboplastin time. @entity1 having delayed or late operations did not differ significantly from @entity1 not receiving streptokinase. Only the interval between time of streptokinase administration and operation could account for the @entity1003 and the @entity260 in the early group. @entity1 in the early group had a higher in-hospital mortality (27% versus 6% for the non-streptokinase group) and major noncardiac morbidity (36% versus 12% for the non-streptokinase group). @entity1 in the delayed and late groups had minimal @entity260 and no mortality. Observations were not explained by differences in total ischemic time, number of @entity177 , or number of @entity1 with @entity1455 between the early group and the non-streptokinase group. @entity86 and massive use of blood products seemed to be contributory factors: Two of three @entity204 in the @entity1 having early operations were associated with clinical suspicion of tamponade. @entity1 undergoing coronary bypass grafting within 12 hours of streptokinase therapy appear to be a high-risk group in a more emergent, uncontrolled clinical setting and require aggressive monitoring and correction of @entity1003 .
