Early intravenous thrombolytic therapy for acute myocardial infarction in patients with prior coronary artery bypass grafts

Treatment of acute myocardial infarction (AMI) with intravenous thrombolytic agents is gaining wide acceptance as a result of the demonstrated ability of fibrinolytic agents to restore coronary arterial patency,¹ improve left ventricular function^2-4 and reduce mortality.^5,6 Most published trials have excluded patients with previous coronary artery bypass grafting, primarily because of difficulty in identifying the infarct-related coronary artery. However, the yearly rate of myocardial infarction is approximately 3% after coronary artery bypass surgery,⁷ and as the number of patients with bypass grafts increases and the population with bypass grafts in place ages, an increasing number of AMIs in this group can be anticipated. No published data exist concerning intravenous thrombolytic therapy in these patients. We report 5 cases of successful thrombolysis using recombinant tissue plasminogen activator (rt-PA) in patients who had previously undergone coronary bypass surgery.