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[Personal experiences with emergency coronary artery revascularization after failed PTCA--early and late results]
1Abteilung für Herzchirurgie, Allgemeines Krankenhaus St. Georg, Hamburg.
Insights
Emergency coronary artery bypass grafting after failed percutaneous transluminal coronary angioplasty is associated with increased risks. However, long-term survival for patients undergoing this procedure is comparable to the general population.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Clinical Outcomes Research
Context:
- Percutaneous transluminal coronary angioplasty (PTCA) techniques have advanced, enabling treatment of complex stenoses.
- Failed PTCA cases necessitate emergency coronary artery bypass grafting (CABG).
- This study evaluates outcomes of emergency CABG following PTCA between 1991 and 1995.
Purpose:
- To assess the outcomes and prognosis of patients requiring emergency CABG after PTCA.
- To analyze perioperative complications, mortality, and long-term survival rates.
Summary:
- 61 patients (1.7%) underwent emergency CABG after PTCA, with a mean age of 61.1 years.
- Perioperative myocardial infarction occurred in 15% of patients, and hospital mortality was 6.6%.
- Long-term follow-up showed 90% actuarial survival at one year, with most survivors in NYHA functional classes I and II.
Impact:
- Emergency CABG post-PTCA is linked to higher mortality and morbidity.
- Incomplete revascularization is common in multi-vessel disease treated with PTCA.
- Despite initial risks, long-term prognosis for survivors is similar to the general population.
Abstract:
In recent years the equipment and techniques for percutaneous transluminal coronary angioplasty (PTCA) have been improved and today complex and distal stenoses are also treated in this way. Subsequent to failed PTCA some patients undergo emergency CABG. Between January 1991 and March 1995 3,520 patients have been treated by PTCA in our hospital. 61 patients (1.7%), mean age 61.1 years, underwent subsequent emergency CABG after PTCA. 46% had single-, 33% double and 21% had triple-vessel-disease, the mean left ventricular function (LVEF) was 65%. The mean number of bypass grafts was 1.9. The internal mammary arteries were never used under these emergency conditions. 9 patients (15%) developed perioperative myocardial infarction and in two of them the LVEF decreased under 30%. The hospital mortality was 6.6% (= 4 perioperative deaths). 6 of 61 patients were lost for follow-up; 90% of the hospitals survivors were followed for 244 months (mean 17). During this period there were 4 late deaths (3 cardiac and 1 non-cardiac). Actuarial survival at one year was 90%. 80% of the long-term survivors were in the NYHA functional classes I and II. In patients with double- or triple-vessel-disease PTCA almost always effects an incomplete revascularisation. Emergency CABG following failed PTCA is associated with an increased mortality and morbidity. The long-term prognosis is similar to that of an age-sex matched general population.