Acute myocardial ischaemia and cardiogenic shock after percutaneous transluminal coronary angioplasty; risk factors for and results of emergency coronary bypass

Abstract

Between 1 September, 1980 and 1 January, 1989, 4142 patients underwent percutaneous transluminal coronary angioplasty (PTCA). We retrospectively studied the 155 [3.7%; 119 males, mean age 53.4 years, (range 33-78 years) and 36 females, mean age 59.6 years (range 40-74 years)] who required urgent coronary artery bypass grafting (CABG) (Group I) and a select control group of 155 patients, in whom PTCA was performed without complications (Group II). Before PTCA, 14 Group I and 42 Group II patients had angina Class II, and 78 Group I and 49 Group II patients had angina class IV (chi 2-test, P less than 0.05). There were 445 complications in the 155 group I patients: 303 (68%) early (during PTCA) and 141 (32%) late (within 24 h). On arrival in the operating room 126 patients were stable; five were in cardiac arrest and 19 in cardiogenic shock (AS-group; 24 patients). In the AS-group and control group, respectively, angina Class II occurred in 2/24 (8.3%) and 42/155 (27.1%) patients, angina Class IV in 14/24 (58.3%) and 49/155 (31.6%) (P less than 0.05), single-vessel disease in 8/24 (33.3%) and 85/155 (54.8%), triple-vessel disease in 7/24 (29.2%) and 23/155 (14.9%) (P less than 0.05); elective PTCA in 11/24 (45.8%) and 92/155 (59.4%), urgent PTCA in 12/24 (50%) and 48/155 (30.9%) (P less than 0.05), PTCA of the left anterior descending artery (LAD) in 18/24 (75%) and 86/166 (51.8%), PTCA of the right coronary artery in 2/24 (8.3%) and 47/166 (28.3%) (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Emergency Coronary Artery Bypass Surgery in the Contemporary Percutaneous Coronary Intervention Era

“…Several large studies from the mid 1980s to early 1990s have reported perioperative Q-wave myocardial infarction in 21% to 57% of patients and in-hospital mortality ranging from 3% to 19%. [2][3][4][5][6][7][8][9] In the stent era, in-hospital complications after emergency CABG have remained high. In the study by Shubrooks et al, 11 mortality and nonfatal Q-wave myocardial infarctions occurred in 29% and 14% of the cases, respectively, in 1997.…”

“…2 Despite this, emergency coronary artery bypass surgery (CABG) is still associated with a significant in-hospital morbidity and mortality. [2][3][4][5][6][7][8][9] We sought to determine the prevalence, indications, predictors, and in-hospital complications of emergency CABG after PCIs in the stent era.…”

Bridge to Operation with the GPIIb/IIIa Inhibitor Abciximab in High-Risk Coronary Patients

“…The majority of trials dealing with emergency coronary surgery after PCI were a reaction to the increasing number of PCIs performed in the late 80's. Considering the widespread use of aspirin, clopidogrel, heparin and GPIIb/IIIa inhibitors these trials do not represent the present situation [11,12] with regard to the incidence of complications due to bleeding. In the last 20 years the rate of emergency surgical revascularization dropped from 2 -4 % to 0.5 -2 % [3,4].…”

Percutaneous transluminal coronary angioplasty (PTCA) without on‐site surgical facilities

“…After failed PTCA emergency CABG has been associated with Q wave myocardial infarction (QWMI) in the range from 20-50% and mortality from 2-15%. 11,[15][16][17][18][19] In fact, by the late 1980s, the use of percutaneous redilatation and perfusion balloons has reduced the rate of emergency CABG. The 1985-6 National Heart, Lung and Blood Institute Registry showed a reduction in overall emergency CABG from 5.8% to 3.5%."…”