Coronary Artery Bypass Grafting after Failed Coronary Angioplasty: Risk Factors and Long-Term Results

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)

Coronary Artery Bypass Grafting After Recent or Remote Percutaneous Coronary Intervention in the Commonwealth of Massachusetts

“…Several studies have reported worse outcomes for patients undergoing CABG after acute PCI associated with complications, [11][12][13][14][15] but few studies have assessed outcomes after CABG procedures after initially successful and uneventful PCI. 16 -18 Moreover, no study has explicitly excluded patients undergoing primary PCI for acute myocardial infarction, where patients are more likely to be treated solely for their culprit lesion, with incomplete revascularization.…”

ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention

“…With the advent of intracoronary stenting, there has been a decrease in the need for emergency CABG ranging between 0.4% and 2% (49,305,(338)(339)(340)(341)(342). Not surprisingly, emergency CABG surgery for a patient with an occluded or dissected coronary artery is associated with a higher mortality than elective surgery (146,(343)(344)(345)(346)(347). Emergency procedures are also associated with high rates of perioperative infarction and less frequent use of arterial conduits.…”

Evaluation of the role of abciximab (Reopro) as a rescue agent during percutaneous coronary interventions: In-hospital and six-month outcomes

“…Rescue abciximab was effective in stabilizing patients experiencing PCI-related ischemic complications such as abrupt vessel closure and compared favorably to historical experience [16,17]. However, the rescue group had a higher incidence of postprocedure MI and a poorer longterm outcome mainly driven by the need for repeat revascularization.…”