Emergency coronary artery bypass surgery following coronary angioplasty--favourable medium term outcome after eight years' experience
Celermajer, D.S.; Bailey, B.P.; Beetson, R.; Zeng, G.E.; Bernstein, L.; Hughes, C.F.
Australian and New Zealand Journal of Medicine 21(2): 211-216
1991
ISSN/ISBN: 0004-8291 PMID: 1872747 Document Number: 368151
The clinical characteristics, perioperative complications and medium term outcome were analysed for patients undergoing emergency coronary artery bypass surgery (CABG) following failed coronary angioplasty (PTCA). Seven hundred and twenty PTCAs were performed from June 1981 to June 1989, of which 30 (4.2%) resulted in CABG within four hours of PTCA. The perioperative course and follow-up were compared to 30 patients undergoing elective CABG, matched retrospectively for age, sex, month of operation and number of grafts. The emergency group had a tendency to more post operative bleeding, but no increased incidence of early reopertion for bleeding, and had a high incidence of periprocedural Q wave infarction (20% vs 3%, p < 0.05). The emergency group had shorter bypass time and decreased use of the internal mammary artery (7% vs 50%, p < 0.05). There was one in-hospital death in the emergency group. At medium term follow-up (3.4 .+-. 2.4, years, range two months to eight years) there was one late death in each group, and seven patients in each group had return of angina or congestive heart failure. Twenty-one patients in the emergency group and 22 patients in the elective group were asymptomatic on no cardiac medications. We conclude that patients with failed PTCA requiring emergency CABG are more likely than an elective group to have post operative bleeding but no increased risk of early reoperation, and have a higher incidence of perioperative Q wave infarction. There is significant difference in operative technique between emergency and elective coronary bypass groups (greater use of the internal mammary artery in the elective group), but not in hospital mortality. Rapid successful surgical revascularisation after failed PTCA resulted in medium term outcome similar to that of patients undergoing elective coronary surgery.