Risk factors for mortality after failed coronary angioplasty: an anesthesia perspective.
Monitored anesthesia care (MAC) for percutaneous transluminal coronary angioplasty (PTCA), and anesthesia for emergent coronary artery bypass graft (CABG) surgery due to failed PTCA, have added relatively new challenges to the cardiac anesthesiologist in community practice. This study attempted to define easily identifiable preangioplasty and periangioplasty risk factors for mortality after failed PTCA. A total of 1,380 angioplasties performed in a single community hospital were retrospectively reviewed; 120 (8.7%) were attempted PTCAs requiring subsequent CABG during the same hospital stay. The 120 failures included 10 surgical mortalities (8.3%); multivariate analysis revealed several significant differences between the mortality and survivor groups. Mortality tended to be higher in insulin-dependent diabetics (P = 0.003), females (P = 0.005), and patients 70 years or over (P = 0.043). Previous CABG, decreased left ventricular ejection fraction, and number of vessels with significant disease did not differ between the groups. Patients who died required more vasopressor agents (P = 0.011) during PTCA and experienced cardiac arrests (P = 0.011) at significantly higher rates than survivors. Left system (left anterior descending or circumflex coronary artery) angioplasty, inability to pass the angioplasty guidewire, and antiarrhythmic drug use did not differ between groups. Data concerning endotracheal intubation in the catheterization laboratory and time from laboratory exit to initiation of cardiopulmonary bypass, while bivariately significant, were too sparse for multivariate analysis. The authors believe that several risk factors for postangioplasty surgical mortality are easily determined without access to diagnostic angiographic studies.(ABSTRACT TRUNCATED AT 250 WORDS)
Nitti
J T
JT
Department of Anesthesia, San Diego School of Medicine, University of California.
Nitti
G J
GJ
Mazzei
W J
WJ
Holbrook
T L
TL
D000367:Age Factors; D000368:Aged; D000758:Anesthesia; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality*; D002140:California / Q000453:epidemiology; D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000628:therapy; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D015996:Survival Rate; D013997:Time Factors; D017211:Treatment Failure; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D014662:Vasoconstrictor Agents