[Coronary angioplasty without surgical standby: a prospective study]

In 811 out of 1000 consecutive patients submitted to coronary angioplasty we elected not to arrange for surgical standby. All patients were informed, and accepted that in case of vessel occlusion an infarction might ensue, for which a conservative management was planned. This choice was made on the basis of a clinical and angiographic estimate of the possible consequences of vessel occlusion, or dictated by sound inoperability of the patient. Primary success was achieved in 700 patients (86%) and in 933/1026 lesions (91%). Fifty-six patients (6.9%) had an acute vessel occlusion (within 24 hours of the procedure), with Q or non Q-wave infarction in 24 cases (2.9% of patients). Emergency coronary stenting was performed in 9 patients. One patient had emergency bypass surgery 1 hour after the procedure, and another had urgent bypass surgery 24 hours after the procedure because of left main stem dissection: the former died despite surgery, the latter was discharged uneventfully. The remaining 7 in-hospital deaths (total mortality 1%) could not have been prevented by surgical standby: one patient died from electromechanical dissociation during the procedure, due to rupture of a ventricular pseudoaneurysm; another died after an uncomplicated procedure, due to an anaphylactic reaction to protamine; two others died suddenly 3 and 20 days, respectively, after a successful procedure; finally, three patients were "a priori" inoperable. Our data suggest that surgical standby is not necessary for a large number of angioplasty candidates, who can be identified on the basis of preliminary clinical and angiographic evidence.(ABSTRACT TRUNCATED AT 250 WORDS)