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Biomedical subjects

W P O'Grady

Publications and source records attributed to W P O'Grady.

8 recordsLinked to original sources
PubMed1981

Surgical treatment of acute evolving anterior myocardial infarction.

A series of 101 consecutive patients underwent coronary revascularization within a mean of 5.8 hours after anterior myocardial infarction. Forty-one patients had obstruction of the left anterior descending coronary artery (LAD), 35 had obstruction of the LAD and of the right or circumflex coronary artery and 25 had obstruction of the LAD and both the right and circumflex coronary arteries. Sixty-four patients (63%) had total occlusion of the LAD. In-hospital mortality was 2%. The total mortality during a mean follow-up of 43 months was 5%, and 90% of the patients were free of angina. Thirty-six patients had repeat coronary arteriography a mean of 13.4 months after operation. Fifty-two of 62 grafts (84%) were patent. Cardiac catheterization and immediate coronary artery bypass grafting in the first hours of anterior myocardial infarction can be done safely and may reduce in-hospital and long-term mortality.

Adult↗
PubMed1981

Immediate coronary artery bypass for acute evolving myocardial infarction.

Two hundred twenty-seven consecutive patients had chest pain and electrocardiographic, coronary angiographic, ventriculographic, and retrospective enzyme changes consistent with acute evolving myocardial infarction (AEMI). These patients underwent coronary artery bypass grafting an average of less than 6 hours after the start of chest pain. The mean age was 55.8 years (range 28 to 79 years). Sex, coronary artery involvement, and preoperative and postoperative enzymes and electrocardiograms are presented. Follow-up angiocardiograms done an average of 12.7 months postoperatively revealed 99 patent primary grafts in 102 patients (94.3%). Ejection fractions were normal, unchanged, or improved in 86.3% of the patients. Two ventricular aneurysms measuring less than 2.5 cm in diameter were noted. Surgical in-hospital mortality was 1.76% and first-year mortality was 1.44%. Conventional therapy in 200 AEMI patients treated at the same hospitals resulted in an in-hospital mortality of 11.5%. Follow-up of 213 patients having coronary artery bypass grafting revealed that 14% had mild angina. AEMI interrupted by coronary artery bypass grafting early in the syndrome yields results which are superior to conventional management.

Acute Disease↗
PubMed1980

Intraaortic balloon counterpulsation with and without reperfusion for myocardial infarction shock.

Forty patients were treated for cardiogenic shock secondary to acute myocardial infarction. Twenty-one (group 1) were treated with intraaortic balloon counterpulsation and 19 (group 2) were treated with counterpulsation and coronary artery bypass grafting. The groups were similar in age, incidence of previous infarction, initial hemodynamics and coronary anatomy. The in-hospital mortality between group 1 (52.4%) and group 2 (42.1%) was not significantly different. The difference in long-term mortality between group 1 and group 2 was substantially different (71.4% vs 47.3%). The subset of group 2 (n = 12) that underwent reperfusion and counterpulsation within 16 hours from the onset of symptoms of infarction had a lower mortality (25.0%) than the subset (n = 7) that underwent operation more than 18 hours after the onset of symptoms (71.4%). The long-term mortality in the subset of group 2 patients operated on within 16 hours after the onset of infarction was significantly different from that in group 1 (25.0% vs 71.4%, p less than 0.03). The data suggest that reperfusion with counterpulsation is more effective when carried out early. Patients who develop shock more than 18 hours after the onset of symptoms of infarction appear to benefit most if treated with counterpulsation alone.

Adult↗