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Emergency aorto-coronary bypass surgery after percutaneous transluminal coronary recanalization--its indication and
Insights
Percutaneous transluminal coronary recanalization (PTCR) for acute myocardial infarction can necessitate emergency aorto-coronary bypass grafting (ACBG). Immediate ACBG after PTCR is recommended for patients with extensive coronary artery disease and severe residual stenosis.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Acute myocardial infarction (AMI) remains a leading cause of mortality worldwide.
- Percutaneous transluminal coronary recanalization (PTCR) is a primary treatment for AMI.
- A subset of patients require further intervention due to residual stenosis or reinfarction.
Purpose of the Study:
- To evaluate the outcomes of PTCR in patients with AMI.
- To identify indications for supplementary aorto-coronary bypass grafting (ACBG) after PTCR.
- To establish criteria for urgent surgical revascularization in complex coronary artery disease.
Main Methods:
- Retrospective analysis of 201 patients undergoing PTCR for AMI.
- Detailed review of patients requiring subsequent ACBG.
- Analysis of non-surviving and medically managed patients with repeated angiography.
Main Results:
- Fifteen patients (7.5%) required emergency ACBG post-PTCR.
- Indications for ACBG included failed thrombolysis or reinfarction within 10 days.
- Patients with left main trunk disease (LMTD) and/or 3-vessel disease (3VD) with >99% residual stenosis benefited from immediate ACBG.
Conclusions:
- PTCR is effective for AMI but requires careful patient selection for subsequent interventions.
- Extensive coronary artery disease (LMTD/3VD) with critical residual stenosis (>99%) post-PTCR is a strong indication for immediate ACBG.
- Timely surgical revascularization improves outcomes in selected high-risk patients post-PTCR.
Abstract:
Percutaneous transluminal coronary recanalization (PTCR) was carried out in 201 patients with acute myocardial infarction. Fifteen patients required emergency aorto-coronary bypass grafting (ACBG) subsequent to PTCR; in one immediately following unsuccessful thrombolysis and the remaining 14 patients within 10 days after initial successful recanalization because of reinfarction. One patient died of multiorgan failure postoperatively. Excluding one patient, all patients had left main trunk disease (LMTD) and/or 3 vessel disease (3VD), with residual stenosis at the site of recanalization of greater than 99% with filling delay. Nonsurviving without surgery and medically managed patients on whom repeated angiography was carried out also analysed, in an effort to establish angiographic indications for supplementary surgical revascularization. Patients having extensive coronary artery disease such as LMTD and/or 3VD, emergency ACBG should be performed immediately following PTCR, if the remaining causative stenosis is greater than 99% with filing delay.