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[Myocardial revascularization for sudden cardiac death in patients after previous coronary angioplasty]
R Jaszewski1, J Zasłonka, M Kośmider
1Kliniki Kardiochirurgii Instytutu Kardiologii Akademii Medycznej w Lodzi.
Insights
Emergency coronary artery bypass grafting (CABG) after percutaneous coronary intervention (PCI) prevents heart attacks. Stent implantation has significantly reduced the need for emergency CABG procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Percutaneous coronary intervention (PCI) is a common procedure for coronary artery disease.
- Complications like dissection and occlusion during PCI can necessitate emergency coronary artery bypass grafting (CABG).
Purpose of the Study:
- To evaluate the outcomes of emergency CABG following PCI.
- To assess the impact of stent implantation on the rate of emergency CABG.
Main Methods:
- Retrospective analysis of patients undergoing emergency CABG after PCI between June 1991 and December 1996.
- Comparison of complication rates before and after the introduction of stent implantation in 1995.
Main Results:
- 14 patients required emergency CABG due to PCI complications (1.3% of 1079 PTCAs).
- The majority of grafts were saphenous vein (18/23).
- Following stent introduction (1995-1996), only 2 emergency CABG procedures were performed (0.4% of PTCAs).
Conclusions:
- Emergency CABG is effective in preventing myocardial infarction and saving lives after PCI complications.
- Stent implantation has substantially decreased the incidence of emergency CABG procedures.
Unlabelled:
PTCA was introduced into our hospital in June 1991. Since then till the end of 1996 emergency CABG operations were performed in fourteen patients. They were indicated because of acute myocardial ischaemia and hemodynamic deterioration that was the result of the dissection and occlusion of a coronary artery during angioplasty. There were 11 male and 3 female patients in this group aged 34 to 65 average 50 years. Twenty-three grafts were performed in total (18 saphenous, 5 using internal mammary artery), that is 1.6 graft per patient. A female patient died of myocardial infarction on the first postoperative day. All other patients survived and are under outpatient clinic's care. Over the analysed 6 years' period of time 1079 PTCAs were performed. The low rate of the unsuccessful procedures (1.3%) that required the emergency CABG is noteworthy. Since 1995, when the implantation of stents was introduced into our hospital, there were only 2 such procedures (0.4% of all PTCAs).
Conclusions:
The CABG operation performed shortly after a dissection and occlusion of the coronary artery underwent angioplasty usually prevents myocardial infarction and saves the patient's live. The introduction of implantation of the stents significantly diminished a number of patients who required an emergency CABG operation.