Impact of delays to cardiac surgery after failed angioplasty and stenting

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Cardiac Surgery

Background:

• Patients undergoing percutaneous coronary intervention (PCI) at hospitals lacking on-site cardiac surgery face extended delays for urgent coronary artery bypass graft (UCABG) surgery.
• These delays can potentially increase the risk of adverse outcomes for patients requiring immediate surgical intervention.

Purpose of the Study:

• To assess the likelihood of harm in patients experiencing delays before undergoing urgent coronary artery bypass graft (UCABG) surgery after a failed percutaneous coronary intervention (PCI).

Main Methods:

• A retrospective chart review was conducted on patients who underwent UCABG following failed PCI.
• A predefined set of criteria, including hemodynamic instability, coronary perforation with effusion/tamponade, or severe ischemia, was used to identify patients at high risk of harm due to surgical delays.

Main Results:

• Out of 6,582 PCIs, 45 patients (0.7%) required UCABG. These patients more frequently had complex type C lesions and urgent indications.
• Among UCABG patients, 17.0% experienced myocardial infarction, and 2 patients died during hospitalization.
• Eleven patients (24.4%) met the criteria for high likelihood of harm with surgical delays. The absolute risk of harm was estimated at 1-2 per 1,000 PCIs.

Conclusions:

• A substantial proportion (approximately 24.4%) of patients referred for UCABG after PCI are at an elevated risk of harm if surgical delays occur.
• These findings highlight the critical need for timely surgical intervention in select PCI patients to mitigate potential adverse events.