To the Editor.—
The article entitled "Surgery for Evolving Myocardial Infarction" (1982;248:1325) by Dr Phillips et al and the accompanying editorial entitled "Coronary Reperfusion: Medical, Surgical, or Not at All?" (1982;248:1362) are interesting, provocative, and dear to the hearts of most practicing cardiac surgeons. I was glad to see that appropriate acknowledgment was given to the pioneering efforts and excellent results achieved by Dr Ralph Berg's group in Spokane, Wash.1 I would like to take exception to several of Dr Phillips' conclusions and suggest a slightly different set of guidelines, as practiced in our community, for patient selection.Contrary to that implied in Dr Phillips' article, single coronary artery occlusions can be catastrophically fatal, associated with horrendous complications, or both. Occlusion of a left anterior descending coronary artery, with its perfusion to the anterior, apical, septal, and occasional apical inferior myocardium, is frequently associated with dire complications. Surely, no
Reid DA. Emergency Revascularization. JAMA. 1983;249(12):1563–1564. doi:10.1001/jama.1983.03330360017011
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