Abstract
Currently emergency revascularization is the basic method of treatment of patients with myocardial infarc
tion with ST elevation (STEMI). Considering the time factor, the choice is in most cases between primary
percutaneous coronary intervention (PCI) and thrombolytic therapy (TLT), possibly in combination with
PCI. However, in some situations, the solver has to question about emergency coronary bypass surgery in
view of multiple coronary artery lesions and the severity of myocardial ischemia, although the first phase of
thrombolytic therapy. In this case it is advisable to decide on the operation off-pump, which ensures less risk
of complications while maintaining the required volume of myocardial revascularization. Such approach was
also used in the presented clinical case. To the patient with STEMI after TLT with recurrence of ischemia of
a myocardium in the sharp period operation off-pump with a full revascularization, good results and with
out hemorrhagic complications was executed.
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