Emergency cardiac surgery after percutaneous coronary intervention: insights from the PROGRESS-Complications Registry

Emergency surgery is an infrequent but severe complication of percutaneous coronary intervention (PCI). The authors sought to examine clinical characteristics, procedural features, and outcomes of patients undergoing emergency cardiac surgery after PCI.

The authors analyzed the clinical characteristics and outcomes of 15 patients who underwent emergency surgery after PCI from the PROGRESS-COMPLICATIONS registry.

Of 18 691 patients who underwent PCI at 2 tertiary care centers between 2016 and 2023, 15 (0.08%) required emergency surgery: 14 underwent coronary artery bypass graft surgery (CABG) and 1 underwent aortic valve replacement and CABG. Patients had high prevalence of comorbidities such as hypertension (93.3%), diabetes mellitus (73.3%), dyslipidemia (93.3%), and prior heart failure (53.3%). The most common presentations included non-ST segment elevation acute myocardial infarction (40.0%) and stable angina (33.3%). Target lesions were complex and often had moderate/severe calcification (60.0%) or involved a bifurcation (40.0%). Mechanical circulatory support was used in 53.3% (intra-aortic balloon pump 12.5%; Impella 2.5 [Abiomed] 12.5%; Impella 5.0 37.5%; Impella CP 12.5%; venoarterial extracorporeal membrane oxygenation 25.0%). In-hospital mortality was 33.3%. The most common indications for emergent CABG were coronary dissection (46.7%), aortocoronary dissection (26.7%), and coronary perforation (26.7%). Post-CABG complications included death (33.3%), arrhythmia (33.3%), hemodynamic instability (26.7%), and cardiogenic shock (13.3%). The median hospital stay was 10.0 days (6.0-18.5). During a median follow-up of 24 months, 53.3% of patients experienced major adverse cardiovascular events (MACE), 46.7% died, and 26.7% required target vessel revascularization.

Patients who underwent emergency surgery after PCI had multiple comorbidities, complex coronary anatomy, and high incidence of MACE.