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Coronary artery bypass grafting after failed coronary angioplasty: risk factors and long-term results
1Department of Cardiac Surgery, University Clinic of Grosshadern, Ludwig-Maximilians University, Munich, Germany.
Insights
Emergency coronary artery bypass grafting after failed percutaneous transluminal coronary angioplasty has higher mortality. Unfavorable stenosis anatomy significantly increases risk in these urgent cardiac surgery cases.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Failed percutaneous transluminal coronary angioplasty (PTCA) necessitates emergency coronary artery bypass grafting (CABG).
- Preoperative risk factors and outcomes of emergency CABG post-PTCA require thorough investigation.
Purpose of the Study:
- To investigate preoperative risk factors and long-term results of emergency CABG following failed PTCA.
- To compare outcomes between emergency CABG after failed PTCA and elective CABG.
Main Methods:
- A case-control study comparing 56 emergency CABGs (Group A) post-failed PTCA with 56 matched elective CABGs (Group B).
- Patients were matched for age, sex, ejection fraction, LVEDP, body surface area, reoperation status, and comorbidities.
- Anatomical criteria for unfavorable PTCA stenoses were defined and assessed.
- Echocardiography was performed postoperatively at 14.6 ± 8.2 months.
Main Results:
- Mortality was significantly higher in the emergency CABG group (10.7%) compared to the elective group (1.8%).
- Patients with anatomically unfavorable stenoses had increased mortality, particularly those with multiple unfavorable criteria (19.0%).
- Proximity of the failed PTCA center influenced outcomes, with higher mortality in patients from the same hospital (14.3%) versus a distant one (4.8%).
Conclusions:
- Emergency CABG after failed PTCA carries a substantial mortality risk.
- Anatomical complexity of coronary stenoses is a critical predictor of adverse outcomes.
- Timely intervention and patient selection are crucial for improving results in this high-risk surgical population.
Abstract:
In this case-control study we investigated the preoperative risk factors and long-term results in patients undergoing emergency coronary artery bypass grafting (CABG) after failed percutaneous transluminal coronary angioplasty (PTCA). From January 1990 to March 1993, 56 emergency CABGs (Group A) were performed in patients from 7 different cardiology centres--six of these located outside our hospital within a radius of 19 km-1 h to 114 h (phi 7.3 h) after failed PTCA. No special stand-by was given and patients were operated in the next available theatre. Criteria of anatomically unfavourable stenoses for PTCA were defined as follows: Long stenoses, occlusions of other major vessels, tandem stenoses, stenoses at or near a bend or branch and, finally, eccentric stenoses. Thirty-two percent met one criterion, 35.8% two, 6.9% three and 1.8% four criteria. All patients were examined echocardiographically 14.6 +/- 8.2 months postoperatively. Patients who had been operated on electively within the same period served as a control (Group B; n = 56; case-control study). The patients were matched for age, sex, EF, LVEDP, body surface area, reoperation status, and concomitant diseases. The mortality rate for Group A patients was 10.7% (n = 6); for Group B, 1.8% (n = 1). Five of the Group A patients who died came from our own hospital and only one from a hospital 1 km away (mortality: 14.3% vs. 4.8%). There were no deaths among patients with an anatomically favourable stenosis for a PTCA; in patients with more than one criterion for an unfavourable stenosis mortality increased to 19.0% (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)