Emergency coronary artery bypass surgery in the contemporary percutaneous coronary intervention era

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Percutaneous coronary interventions (PCIs) have advanced, reducing complications.
• Emergency coronary artery bypass surgery (CABG) following PCI still carries significant risks.
• The study examines emergency CABG after PCI over a decade.

Purpose of the Study:

• To determine the prevalence of emergency CABG after PCI.
• To identify indications, predictors, and complications of emergency CABG.
• To analyze trends in emergency CABG over a ten-year period.

Main Methods:

• Retrospective review of 18,593 PCIs performed between 1992 and 2000.
• Analysis of indications for emergency CABG, including dissection, perforation, and acute closure.
• Statistical analysis to identify predictors and complications.

Main Results:

• Emergency CABG was required in 0.61% of PCIs.
• Indications included extensive dissection (54%), perforation/tamponade (20%), and acute closure (20%).
• Prevalence decreased from 1.5% to 0.14% (P<0.001). Predictors: higher ACC/AHA score, female sex. Protective factors: prior bypass, stent use.

Conclusions:

• The need for emergency CABG post-PCI has significantly declined.
• Female sex and higher lesion severity (ACC/AHA score) are risk factors.
• Despite the decrease, emergency CABG remains associated with high morbidity and mortality.