Coronary artery bypass grafting (CABG) after initially successful percutaneous transluminal coronary angioplasty (PTCA): a review of 17 years experience.
OBJECTIVE
Patients who undergo successful percutaneous transluminal coronary angioplasty (PTCA) may subsequently require operative myocardial revascularization. This review examines whether prior successful PTCA alters outcomes following subsequent coronary artery bypass grafting (CABG). The costs of interventional cardiology procedures and definitive surgery were also examined.


METHODS
From January 1981 through December 1997, 361 patients underwent CABG following initially successful PTCA (interval group). This group was compared with 11,909 patients who underwent CABG as the primary intervention for coronary artery disease (control group).


RESULTS
The average time interval to CABG following initial PTCA was 13.7 months. The post-CABG myocardial infarction rate was 4% for patients in the interval group and 3% for patients in the control group. The 30-day mortality was similar for both patient groups (2%). For the interval group, the average cost of total interventional management was 24,220 dollars per patient. This included average costs of 13,873 dollars for CABG and 10,347 dollars for all preoperative interventional cardiology procedures.


CONCLUSIONS
There is little doubt that PTCA procedures may provide successful myocardial revascularization. However, these procedures often need to be repeated over time and may serve only to delay coronary surgery, at substantial financial and personal cost.
Barakate
M S
MS
The University of Sydney, Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, The Baird Institute for Heart and Lung Surgical Research, Sydney, NSW, Australia.
Hemli
J M
JM
Hughes
C F
CF
Bannon
P G
PG
Horton
M D
MD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D016009:Chi-Square Distribution; D017023:Coronary Angiography / Q000191:economics; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D003327:Coronary Disease / Q000601:surgery / Q000628:therapy*; D003365:Costs and Cost Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018579:Patient Selection; D011183:Postoperative Complications; D011446:Prospective Studies; D016896:Treatment Outcome