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December 8, 1978

Coronary Bypass Surgery for Cardiogenic Shock

Author Affiliations

Veterans Administration Hospital Palo Alto, Calif

JAMA. 1978;240(24):2631. doi:10.1001/jama.1978.03290240031010

To the Editor.—  Recently, a reader inquired if there is any present indication for emergency coronary bypass surgery in "patients with refractory cardiac power failure after myocardial infarction but no associated mitral valve insufficiency or ventricular septal defect" (240:385,1978).Three consultants gave an affirmative answer. One stated that the use of "circulatory assistance particularly with the intra-aortic balloon pump (IABP) in combination with emergency cardiac surgery has reduced the mortality to between 30% and 40%." The consultant also added that "coronary artery bypass graft surgery alone may on occasion save lives that otherwise would be lost." Four references were cited by the consultants to support their opinions.To my knowledge, there are no published data including the four cited references that support this opinion. The combination of IABP and coronary surgery has not been evaluated using appropriate medical controls despite the obvious need for such studies. In one cited reference