Emergency surgery after unsuccessful coronary angioplasty: a review of 15 years' experience.
BACKGROUND
Emergency coronary artery bypass grafting (CABG) is occasionally necessary for failed percutaneous transluminal coronary angioplasty (PTCA). The aim of this study was to assess the outcome of patients receiving emergency CABG after unsuccessful PTCA over a 15-year study period.


METHODS
From January 1982 through December 1996, 74 patients underwent emergency CABG after unsuccessful PTCA (crash group). This group was compared with a matched group of 74 patients having primary elective CABG (control group).


RESULTS
All 74 crash group patients were to have PTCA of one coronary system. After PTCA failure, 58 patients (78.3%) developed electrocardiographic changes of evolving acute myocardial infarction (AMI). The overall rate of AMI was 8.1% for the crash group and 2.7% for the control group. Two patients in the crash group died, with no deaths in the control group. There was no significant difference between mean in-hospital length of stay.


CONCLUSIONS
With prompt, aggressive, and complete myocardial revascularization, patients who required emergency CABG after PTCA failure had an outcome not significantly different from that of patients having elective CABG.
Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia. clifford.hughes@email.cs.nsw.gov.au
Michael S
MS
Barakate
Paul G
PG
Bannon
Clifford F
CF
Hughes
Matthew D
MD
Horton
Ann
A
Callaway
Tara
T
Hurst
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass / Q000009:adverse effects; D004562:Electrocardiography; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis; D015425:Myocardial Reperfusion; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome