Emergency coronary artery bypass surgery for percutaneous coronary interventions: changes in the incidence, clinical characteristics, and indications from 1979 to 2003.
OBJECTIVE
The purpose of the current study was to evaluate the changes in incidence, clinical characteristics, and indications for emergency coronary artery bypass grafting (CABG) in patients undergoing percutaneous coronary intervention (PCI) from 1979 to 2003.


BACKGROUND
Emergency CABG after PCI is associated with significant morbidity and mortality.


METHODS
Data from 23,087 patients who underwent PCI at Mayo Clinic from 1979 to 2003 were analyzed. Patients were divided into three groups: the "pre-stent" era, 1979 to 1994 (n = 8,905); the "initial stent era," 1995 to 1999 (n = 7,605); and the "current stent era," 2000 to 2003 (n = 6,577).


RESULTS
Although patients undergoing PCI in the recent time periods had more high-risk features, there was a significant decrease in the incidence of emergency CABG from 2.9% to 0.7% to 0.3% across the groups (p < 0.001). Patients requiring emergency surgery in the recent time periods had a higher prevalence of hypertension, prior revascularization, and left ventricular dysfunction (ejection fraction <40%), as well as more complex coronary lesions. Fewer patients in the current stent era had coronary artery dissections and abrupt vessel closure requiring emergency CABG. The in-hospital mortality rate for emergency CABG patients remains unchanged and ranges from 10% to 14%.


CONCLUSIONS
The current study demonstrates that despite the increase in high-risk patients undergoing PCI, there has been a marked decrease in the incidence of patients requiring emergency CABG. However, the in-hospital mortality rate for those requiring emergency CABG remains high and unchanged.
Yang
Eric H
EH
Division of Cardiovascular Disease and Internal Medicine, Mayo College of Medicine, Rochester, Minnesota 55905, USA.
Gumina
Richard J
RJ
Lennon
Ryan J
RJ
Holmes
David R
DR
Rihal
Charanjit S
CS
Singh
Mandeep
M
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002423:Cause of Death; D001026:Coronary Artery Bypass / Q000401:mortality / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000453:epidemiology / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000601:surgery; D004638:Emergency Treatment; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000627:therapeutic use; D012189:Retrospective Studies; D015607:Stents; D013318:Stroke Volume; D017211:Treatment Failure; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology
D019039:Platelet Glycoprotein GPIIb-IIIa Complex