Staged revascularization in critically ill patients with coronary artery disease.
BACKGROUND
Critically ill patients undergoing bypass surgery experience a higher mortality and morbidity.


OBJECTIVE
The study was undertaken to evaluate the efficacy and value of percutaneous transluminal coronary angioplasty (PTCA) as a bridge to coronary artery bypass graft surgery (CABG) in high-risk patients with refractory unstable angina or cardiogenic shock.


METHODS
We present 11 seriously unstable patients with severe multivessel coronary artery disease undergoing culprit vessel PTCA. Angioplasty was performed not as a definitive procedure but rather as a bridge to surgical revascularization. All the patients had sustained at least one myocardial infarction prior to catheterization, all had refractory unstable angina, eight patients had only a single patent coronary artery, and five patients were in cardiogenic shock.


RESULTS
Following PTCA, all patients enjoyed a stable in-hospital period. One patient died 12 weeks after successful PTCA while awaiting second CABG. Seven patients subsequently underwent CABG and are doing well. The remaining three patients were also advised to undergo CABG, but elected to continue medical management.


CONCLUSIONS
Coronary angioplasty of the culprit vessel may play a role as a bridge to surgery in critically ill patients.
Hayat
N J
NJ
Chest Diseases Hospital, Safat, Kuwait.
Varghese
K
K
Thomas
C S
CS
Khan
N A
NA
D000368:Aged; D000789:Angina, Unstable / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000601:surgery / Q000628:therapy*; D016638:Critical Illness; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D012770:Shock, Cardiogenic / Q000628:therapy*; D015607:Stents