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[Results of emergency bypass operation following percutaneous transluminal coronary angioplasty]
B Sievers1, J Schofer, P Kalmar
1Abteilung für Kardiologie, Universitätskrankenhaus Eppendorf, Hamburg.
Insights
Emergency bypass surgery after percutaneous transluminal coronary angioplasty (PTCA) led to myocardial infarction in 45% of patients. Higher pre-procedure stenosis and lower ejection fraction increased risks, while successful reperfusion reduced infarction rates.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Context:
- Percutaneous transluminal coronary angioplasty (PTCA) is a common procedure for coronary artery disease.
- Complications such as acute vessel occlusion or dissection can necessitate emergency coronary artery bypass grafting (CABG).
- Understanding risk factors for adverse outcomes after emergency CABG is crucial for patient management.
Purpose:
- To analyze the incidence of myocardial infarction and mortality following emergency coronary artery bypass surgery (CABG) in patients who underwent percutaneous transluminal coronary angioplasty (PTCA).
- To identify factors influencing the occurrence of myocardial infarction and death in this patient cohort.
Summary:
- Between 1980 and 1988, 1,514 patients underwent PTCA, with 55 (3.6%) requiring emergency CABG.
- Of these, 25 patients (45%) experienced myocardial infarction, and 5 (9%) died. Higher degrees of stenosis in the dilated vessel correlated with increased infarction rates.
- Successful reperfusion strategies (reperfusion catheter, repeat PTCA, intracoronary lysis) reduced the incidence of infarction to 27%.
Impact:
- The degree of vessel stenosis during PTCA significantly impacts the likelihood of perioperative myocardial infarction.
- Lower left ventricular ejection fraction before PTCA is a significant predictor of mortality after emergency CABG.
- These findings highlight the importance of pre-procedural assessment and successful reperfusion techniques in mitigating risks associated with emergency CABG following PTCA.
Abstract:
Between 1980 and 1988, percutaneous transluminal coronary angioplasty (PTCA) was performed in 1,514 patients. Fifty-five patients (3.6%) underwent emergency coronary bypass surgery because of an acute occlusion of the vessel or a dissection with sustained angina and signs of ischemia on the electrocardiogram. Twenty-five of these 55 patients had a myocardial infarction and 5 patients died, 3 perioperatively, 2 after hospital discharge. The degree of stenosis of the dilated vessel significantly influenced the incidence of infarction, while left ventricular ejection fraction prior to PTCA significantly influenced mortality. Patients who underwent surgery with an occluded vessel experienced myocardial infarction significantly more often (87%) than patients with a patent vessel (24%). The incidence of infarction was 27% when reperfusion of the vessel occluded during PTCA was achieved with a reperfusion catheter, repeated PTCA or intracoronary lysis. The patients' age, presence of unstable angina, left ventricular ejection fraction prior to PTCA, the dilated vessel, the extent of coronary artery disease, collateralization of the dilated vessel, and the time between the onset of the event necessitating bypass surgery and the beginning of extracorporeal circulation were found to have no influence on the incidence of infarction. Patients who died had a significantly lower ejection fraction before PTCA than survivors and all patients who died had experienced a large perioperative myocardial infarction.