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Surgical standby for coronary balloon angioplasty
1Cardiology Center, University Hospital, Geneva, Switzerland.
Insights
Performing coronary angioplasty without surgical standby in selected patients did not increase risk. This approach is ethically feasible when logistic factors necessitate it, demonstrating safety in carefully chosen cases.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Surgical Risk Assessment
Background:
- Coronary balloon angioplasty is a common procedure for treating coronary artery disease.
- The need for emergency surgery following angioplasty has been a concern, impacting procedural planning and resource allocation.
- The role of surgical standby during angioplasty requires careful evaluation to optimize patient care and healthcare efficiency.
Purpose of the Study:
- To evaluate the predictability of emergency surgery requirements after coronary balloon angioplasty.
- To assess the safety and feasibility of performing coronary angioplasty without immediate surgical backup in certain patient populations.
Main Methods:
- A nonrandomized intervention study was conducted at a nonprofit university hospital.
- 1000 consecutive patients undergoing coronary angioplasty were allocated to either a
- standby
- group (189 patients) or a
- no-standby
- group (811 patients).
- Key outcome measures included the need for bypass surgery, myocardial infarction, and mortality.
Main Results:
- The rates of immediate bypass surgery were low and similar in both groups (0.5% vs. 0.1%).
- Myocardial infarction rates were comparable (5% vs. 4%).
- All eight deaths occurred in the
- no-standby
- group, but were not attributed to the absence of surgical standby, occurring in complex clinical scenarios.
Conclusions:
- Performing coronary angioplasties without surgical standby in approximately 80% of cases did not elevate patient risk.
- Coronary angioplasty without surgical backup is ethically feasible in selected patients, particularly when logistical considerations are paramount.
Objective:
To assess the predictability of need for emergency surgery after coronary balloon angioplasty.
Design:
Nonrandomized intervention study.
Setting:
Nonprofit university hospital.
Patients:
Prior to balloon angioplasty, 1000 consecutive patients were assigned to either the "standby" group (189 patients [19%]) or the "no-standby" group (811 patients [81%]). Patients in the standby group (intervention coordinated with cardiac surgery) included all operable patients undergoing angioplasty of their largest coronary arteries that were not currently or previously totally occluded or collateralized; the no-standby group consisted of the remainder of patients.
Intervention:
Allocation to coronary angioplasty with or without surgical standby.
Main Outcome Measures:
Need for bypass surgery, occurrence of myocardial infarction, and mortality from complications of angioplasty.
Results:
Bypass surgery immediately after angioplasty was done in one patient in each group (standby, 0.5%, vs no-standby, 0.1%). The frequency of infarction was 5% vs 4%, respectively. All eight deaths occurred in the no-standby group (1.0%), but none of them were consequences of a lack of surgical standby. They occurred in situations in which bypass surgery would not have changed the outcome (two cardiac failures late after technically successful angioplasty for postinfarct cardiogenic shock, one in-laboratory rupture of an unrecognized ventricular pseudoaneurysm, and one protamine reaction), secondary to acute problems late after successful angioplasty (two sudden deaths and one vessel occlusion in an inoperable patient), or despite surgery (one patient with left main stem dissection).
Conclusions:
Performing roughly 80% of coronary angioplasties without surgical standby did not increase patient risk. Coronary angioplasty without surgical backup, albeit not an ideal setting, appears ethically feasible in selected patients if dictated by logistic considerations.
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