Factors influencing mortality after emergency coronary artery bypass grafting for failed percutaneous transluminal coronary angioplasty.
BACKGROUND
Emergency coronary artery bypass grafting after failed percutaneous transluminal coronary angioplasty is associated with increased mortality.


METHODS
From 1981 through 1995, 117 patients at our institution underwent emergency coronary artery bypass grafting after failed percutaneous transluminal coronary angioplasty, with an in-hospital mortality rate of 13.6%. Univariate and multivariate analyses were used to identify the factors that influenced the risk of death.


RESULTS
Univariate analysis revealed that patients who died more often were women and had chronic renal failure, lower ejection fractions, and more diffuse coronary artery disease; less often received an internal mammary artery graft or an antegrade perfusion catheter; required inotropic support in the cardiac catheterization laboratory; and experienced myocardial infarction. Multivariate analysis demonstrated that the need for inotropic support in the cardiac catheterization laboratory was the best predictor of perioperative death.


CONCLUSIONS
Patients with a reduced ejection fraction in whom percutaneous transluminal coronary angioplasty fails, antegrade perfusion does not produce a response, and myocardial infarction occurs are more likely to die after coronary artery bypass grafting. The risk appears to be highest for patients who require inotropic support in the cardiac catheterization laboratory.
Lazar
H L
HL
Department of Cardiothoracic Surgery, The Boston Medical Center, Massachusetts 02118, USA.
Jacobs
A K
AK
Aldea
G S
GS
Shapira
O M
OM
Lancaster
D
D
Shemin
R J
RJ
D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary; D006328:Cardiac Catheterization; D002316:Cardiotonic Agents / Q000627:therapeutic use; D001026:Coronary Artery Bypass / Q000401:mortality*; D003327:Coronary Disease / Q000473:pathology; D004630:Emergencies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D013318:Stroke Volume; D016896:Treatment Outcome
D002316:Cardiotonic Agents