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Changing profiles of failed coronary angioplasty patients: impact on surgical results
H L Lazar1, D P Faxon, G Paone
1Department of Cardiothoracic Surgery, Boston University Medical Center, Massachusetts.
Insights
Emergent coronary artery bypass grafting after failed percutaneous transluminal coronary angioplasty (PTCA) shows stable outcomes. Despite sicker patients undergoing PTCA, surgical results for emergent bypass grafting remain consistent.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Increasingly, high-risk patients undergo percutaneous transluminal coronary angioplasty (PTCA).
- Patient profiles undergoing PTCA may be changing, potentially impacting outcomes of emergent coronary artery bypass grafting (CABG).
Purpose of the Study:
- To compare patient profiles undergoing emergent CABG after failed PTCA over time.
- To assess the impact of changing patient profiles on operative morbidity and mortality.
Main Methods:
- Retrospective analysis of 53 patients undergoing emergent CABG post-PTCA (1980-1988).
- Patients divided into two groups: 1980-1985 (Group I) and 1986-1988 (Group II).
- Comparison of demographic, clinical, and angiographic data, along with operative outcomes.
Main Results:
- Group II patients were older, more likely to have unstable angina, lower ejection fractions, and more diseased vessels.
- No significant differences observed in perioperative myocardial infarction rates (37% vs. 39%).
- Thirty-day operative mortality (11% vs. 11%) and major postoperative complications (14% vs. 22%) were similar between groups.
Conclusions:
- Despite evolving patient profiles with increased comorbidities and disease severity undergoing PTCA, emergent CABG outcomes remain stable.
- This suggests that advancements in care or patient selection have mitigated risks associated with sicker patients requiring emergent bypass after failed PTCA.
Abstract:
As more high-risk patients undergo percutaneous transluminal coronary angioplasty (PTCA), the changing profiles of PTCA patients who may require emergent coronary artery bypass grafting may alter operative morbidity and mortality. This study compared profiles of recent patients undergoing emergent coronary artery bypass grafting after a failed PTCA with earlier patients to determine their impact on operative results. From 1980 to 1988, 53 patients underwent emergent coronary artery bypass grafting after a failed PTCA at the Boston University Medical Center. These patients were divided into two groups based on the year of the PTCA: group I, 1980 to 1985 (n = 18); and group II, 1986 to 1988 (n = 35). Group II patients tended to be older (age greater than or equal to 65 years, 47% group II versus 11% group I), were more likely to have unstable angina before PTCA (74% versus 33%), and had lower ejection fractions (0.53 +/- 0.02 versus 0.63 +/- 0.05) and more vessels with 50% or greater stenosis (2.1 +/- 0.2 versus 1.6 +/- 0.2). Nevertheless, there was no significant difference in the incidence of perioperative myocardial infarcts using enzyme and electrocardiographic criteria (37% in group II versus 39% in group I), 30-day operative mortality (11% in group II versus 11% in group I), or major postoperative complications (14% in group II versus 22% in group I). We conclude that despite the changing profiles of patients undergoing PTCA, which include older patients with more extensive coronary artery disease and lower ejection fractions, operative results after emergent coronary artery bypass grafting for failed PTCAs remain unchanged.