Factors Influencing Mortality After Emergency Coronary Artery Bypass Grafting for Failed Percutaneous Transluminal Coronary Angioplasty

Emergency Coronary Artery Bypass Surgery for Percutaneous Coronary Interventions

“…We observed a mortality rate of 10% to 14%, which is similar to the rate of 15% reported by Seshadri et al (6). These rates are much higher than those for elective CABG, and a previous study suggests that the high mortality rate may be due to the hemodynamic instability that is present at the time of emergency surgery (15). This instability can lead to a lower probability of receiving an internal mammary graft and a greater requirement for inotropic support and blood products (15,16).…”

“…These rates are much higher than those for elective CABG, and a previous study suggests that the high mortality rate may be due to the hemodynamic instability that is present at the time of emergency surgery (15). This instability can lead to a lower probability of receiving an internal mammary graft and a greater requirement for inotropic support and blood products (15,16). The most common causes of death in these patients were postoperative myocardial infarction and cardiac arrhythmias.…”

Impact of delays to cardiac surgery after failed angioplasty and stenting

“…The patients most likely to survive had emergent surgery (39%) or pericardiocentesis. The criteria regarding new ST elevation or persistent ST depression and hemodynamic instability were based on data from several registries, including the Boston Medical Center group (19) and the summary data by Block et al (17) from eight cardiac databases. Electrocardiographic (ECG) changes after failed PCI before emergency bypass surgery were associated with increased mortality (19).…”

“…The criteria regarding new ST elevation or persistent ST depression and hemodynamic instability were based on data from several registries, including the Boston Medical Center group (19) and the summary data by Block et al (17) from eight cardiac databases. Electrocardiographic (ECG) changes after failed PCI before emergency bypass surgery were associated with increased mortality (19). Consistent with clinical experience, patients who have ischemic territories at risk for longer durations generally have larger infarctions and more adverse events.…”

“…Hemodynamic instability has been shown to be the most important predictor of survival after failed PCI in patients having UCABG (17,19). Patients who become hemodynamically unstable after a failed PCI generally have a limited reserve to withstand delays to surgery.…”