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Emergency aortocoronary bypass after failed angioplasty
M A Greene1, L A Gray, A D Slater
1Department of Surgery, University of Louisville School of Medicine, Kentucky 40202.
Insights
Emergency coronary artery bypass grafting after failed percutaneous transluminal coronary angioplasty leads to higher risks. Patients with multiple-vessel coronary artery disease face increased complications and mortality, highlighting the need for careful consideration.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) is a common revascularization procedure.
- Angioplasty failure necessitates emergency coronary artery bypass grafting (CABG).
Purpose of the Study:
- To evaluate the outcomes of emergency CABG following failed PTCA.
- To compare morbidity and mortality between single-vessel and multiple-vessel coronary artery disease patients undergoing emergency CABG.
Main Methods:
- Retrospective analysis of 1214 PTCA procedures over 38 months.
- Inclusion of 53 patients who underwent emergency CABG after angioplasty failure.
- Comparison of postoperative outcomes based on disease extent (single-vessel vs. multiple-vessel).
Main Results:
- 51% of patients experienced postoperative myocardial infarction.
- Emergency CABG had a 4% mortality rate and 19% complication rate.
- Multiple-vessel disease patients showed higher rates of intraaortic balloon pump use, antiarrhythmic medication, and complications.
Conclusions:
- Emergency CABG after failed PTCA is associated with significant morbidity and mortality.
- Multiple-vessel coronary artery disease is a risk factor for poorer outcomes in this setting.
- These findings underscore the risks of emergency CABG, especially in complex coronary artery disease.
Abstract:
One thousand two hundred fourteen percutaneous transluminal coronary angioplasties were performed over a 38-month period. Sixty patients required immediate emergency coronary artery bypass grafting after angioplasty failure; 7 of these had evidence of acute myocardial infarction before angioplasty and were excluded from the study. Of the 53 patients remaining, 27 (51%) had electrocardiographic and enzyme evidence of postoperative myocardial infarction. Two patients died (4%), and 10 had postoperative complications (19%). No statistical significance was noted comparing age, sex, incidence of prior myocardial infarction or myocardial dysfunction, time for revascularization, or average number of grafts completed in those with single-vessel (n = 21) versus multiple-vessel (n = 32) coronary artery disease. Postoperatively, those with multiple-vessel disease required intraaortic balloon pump support (p = 0.06) and antiarrhythmic medications more frequently than single-vessel patients (p less than 0.01) and had a higher complication rate (p less than 0.05). Although not reaching statistical significance, the data also suggest a higher death and postoperative myocardial infarction rate in patients with multiple-vessel disease. Emergency coronary artery bypass grafting after failed percutaneous transluminal coronary angioplasty carries a higher morbidity and mortality than elective coronary artery bypass grafting, particularly for patients with multiple-vessel coronary artery disease.