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Related Experiment Videos

Have PTCA failures requiring emergent bypass operation changed?

M J Boylan1, B W Lytle, P C Taylor

  • 1Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Ohio 44195.

The Annals of Thoracic Surgery
|February 1, 1995
PubMed
Summary

Percutaneous transluminal coronary angioplasty (PTCA) failure rates requiring emergency surgery decreased from 1980-1990. However, in-hospital mortality for these emergent cases showed an increasing trend, linked to patient hemodynamic compromise.

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Balloon angioplasty, or percutaneous transluminal coronary angioplasty (PTCA), is a common procedure.
  • PTCA failure can necessitate emergent surgical revascularization.
  • Understanding trends in PTCA failure and outcomes is crucial for improving patient care.

Purpose of the Study:

  • To analyze trends in PTCA failure rates requiring emergent surgery.
  • To evaluate changes in patient characteristics and outcomes over time.
  • To identify factors associated with in-hospital mortality after emergent surgical revascularization.

Main Methods:

  • Retrospective analysis of 9,145 patients undergoing PTCA between 1980 and 1990.
  • Patients were divided into two cohorts: 1980-1985 and 1986-1990.

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  • Comparison of PTCA failure rates, pre-procedural characteristics, and in-hospital/late survival.

    • Main Results:

    • PTCA failure incidence decreased from 3.8% (1980-1985) to 2.3% (1986-1990).
    • In-hospital mortality for emergent surgery increased from 4.6% to 7.6%, though not statistically significant.
    • Higher mortality was strongly associated with severe hemodynamic compromise (28.3% vs 1.4%).
    • Preoperative intraaortic balloon pump use increased significantly.

    Conclusions:

    • While PTCA failure rates have declined, emergent surgical revascularization carries significant risk.
    • Increased mortality in later years appears linked to sicker patients undergoing surgery, not necessarily pre-PTCA characteristics.
    • Severe hemodynamic compromise is a major predictor of mortality in this high-risk group.