Emergency coronary artery bypass grafting after failed coronary angioplasty: what has changed in a decade?
H Reinecke1, T Fetsch, N Roeder
1Department of Cardiology and Angiology/Institute for Arteriosclerosis Research, Hospital of the Westfälische Wilhelms-University, Münster, Germany.
Insights
Emergency coronary artery bypass grafting (CABG) after failed percutaneous transluminal coronary angioplasty (PTCA) decreased. However, patient risk factors and complications increased, leading to a trend of higher perioperative mortality.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Health Services Research
Background:
- Assessing patient and procedural factors influencing outcomes of emergency coronary artery bypass grafting (CABG) following failed percutaneous transluminal coronary angioplasty (PTCA).
- Analyzing temporal shifts in these influencing factors over distinct clinical practice periods.
Purpose of the Study:
- To evaluate the impact of patient and procedural characteristics on emergency CABG outcomes post-PTCA.
- To identify changes in these characteristics and their effect on mortality and morbidity over time.
Main Methods:
- Retrospective analysis of patients undergoing PTCA and emergency CABG from cardiology and cardiothoracic surgery databases.
- Comparison of two clinical practice periods: 1989–1993 and 1994–1998.
Main Results:
- Emergency CABG rates after PTCA decreased from 2.3% to 1.2% (p < 0.01).
- Perioperative mortality showed a non-significant increase from 10.9% to 15.2%.
- The later period saw increased stenting (0.8% to 24%), arterial grafts (0% to 39%), older patients, more females, higher cardiovascular risk, increased Cleveland scores, and more periprocedural myocardial infarctions and complications.
Conclusions:
- Despite a decline in emergency CABG frequency post-PTCA, perioperative mortality trended upward.
- This trend is attributed to an unfavorable shift in patient risk profiles and increased periprocedural morbidity.
Background:
We assessed the impact of patient and procedural characteristics on the outcome after emergency coronary artery bypass grafting (CABG) for failed percutaneous transluminal coronary angioplasty (PTCA) and temporal changes in these factors.
Methods:
Patients who underwent PTCA and subsequent emergency CABG were identified from the databases of the Departments of Cardiology and Cardiothoracic Surgery.
Results:
Two periods of clinical practice were compared. In 1989 to 1993, 2,880 PTCAs were performed, 64 patients underwent emergency CABG (2.3%), and 7 patients died (10.9%). During 1994 to 1998, 46 patients of 3,801 PTCAs underwent emergency CABG (1.2%, p < 0.01), and 7 patients died (15.2%, NS). The average rate of stenting increased from 0.8% to 24% in 1994 to 1998 as well as the frequency of arterial bypass grafts (0% vs 39%). In the latter period, patients were older, were more often females, had more cardiovascular risk factors, a higher Cleveland score (each p < 0.05), and suffered more often from periprocedural myocardial infarctions (p < 0.001) and nonfatal periprocedural complications (p < 0.01).
Conclusions:
Although the frequency of emergency CABG after failed PTCA declined, perioperative mortality tended to increase according to an unfavorable shift in patient risk factors and morbidity.
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