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Early and long-term outcome after emergency coronary artery bypass surgery after failed coronary angioplasty
P Buffet1, N Danchin, J P Villemot
1Départment des Maladies CardioVasculaires, Chu Nancy-Brabois, Vandoeuvre-lès-Nancy, France.
Insights
Emergency coronary artery bypass graft surgery after failed percutaneous transluminal coronary angioplasty (PTCA) had a high in-hospital mortality (19%). However, long-term survival for patients with coronary artery disease was favorable, with most experiencing symptom relief and returning to work.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) is a common procedure for coronary artery disease.
- Complications can necessitate emergency coronary artery bypass graft (CABG) surgery.
- Outcomes of emergency CABG after failed PTCA require detailed analysis.
Purpose of the Study:
- To evaluate the in-hospital and long-term outcomes of patients undergoing emergency CABG following failed PTCA.
- To identify predictors of operative mortality in this patient cohort.
- To assess the long-term clinical status and quality of life after emergency CABG.
Main Methods:
- Retrospective analysis of 2,576 PTCA procedures from April 1980 to January 1990.
- Identification of 100 patients who underwent emergency CABG after failed PTCA.
- Kaplan-Meier survival analysis for long-term outcomes.
- Assessment of clinical status, including chest pain, dyspnea, and return to work.
Main Results:
- In-hospital mortality was 19%.
- Operative mortality was associated with older age, unstable angina, and cardiogenic shock or cardiac massage.
- Seven-year survival was 94% for hospital survivors.
- At long-term follow-up (mean 55 months), 78% were pain-free, and 80% had no dyspnea.
- 73% of previously employed patients resumed work.
Conclusions:
- Emergency CABG after failed PTCA carries significant in-hospital risk.
- Despite initial mortality, long-term survival and clinical outcomes are satisfactory for survivors.
- Patient selection and management of pre-operative instability are crucial for improving outcomes.
Abstract:
From April 1980 to January 1990, among 2,576 percutaneous transluminal coronary angioplasty (PTCA) procedures, 100 patients (82 men and 18 women; mean age, 54 +/- 10 years [3.9%]) underwent emergency coronary artery bypass graft surgery. Before PTCA 56 had unstable angina, 34 had prior myocardial infarction, and 60 had single-vessel coronary artery disease. The mean time period from the onset of ischemia to surgical reperfusion was 147 +/- 16 minutes; 155 grafts were placed (1.5 grafts per patient). In-hospital mortality was 19%; operative mortality was significantly related to older age (59 +/- 9 versus 53 +/- 10 years, p less than 0.05), presence of unstable angina (74% versus 53%, p less than 0.05), and development of cardiogenic shock or necessity of cardiac massage before surgery (53% versus 16%, p less than 0.0001). In addition, 57 patients developed a Q wave myocardial infarction. For hospital survivors, overall survival at 7 years was 94% (Kaplan-Meier method), with three cardiac deaths during follow-up; two additional patients had late myocardial infarction, and four had late PTCA. At a mean follow-up of 55 +/- 38 months, 78% of the patients had no chest pain, and 80% reported no dyspnea. All patients received antiplatelet agents or oral anticoagulants; 34% had no antianginal medications. Among the 40 previously employed patients, 73% resumed work after surgery. All patients with cardiogenic shock or cardiac massage who survived the initial hospital period were alive at follow-up. After an initial critical period, the long-term clinical outcome of patients with emergency coronary bypass surgery after failed PTCA is satisfactory.