Fewer Emergency Bypass Surgeries Needed for Failed Angioplasty

During the last decade, the overall safety of angioplasty has improved markedly, thanks largely to greater physician experience, improved techniques, new thrombolytic agents, and mechanical devices such as stents.

That’s according to Dr. Patrick L. Whitlow, and colleagues from the Cleveland Clinic Foundation in Ohio, who reviewed the medical records of 18,593 patients who underwent percutaneous coronary interventions (PCIs) between 1992 and 2000. One hundred thirteen (0.61%) of the patients required emergency coronary artery bypass surgery (CABG), most often for extensive dissection (54%), perforation/tamponade (20%), and recurrent acute closure (20%).

In a rapid access issue of Circulation: Journal of the American Heart Association, the researchers report that there was a 10-fold decline in the need for emergency CABG for failed PCIs over the study period. Specifically, the prevalence of emergency bypass fell from 1.5% in 1992 to 0.14% in 2000 (p < 0.001). "In parallel, Q-wave myocardial infarction and death also significantly declined over time," the authors report. Independent risk factors for emergency CABG include female sex (p = 0.028) and a higher ACC/AHA score of the treated lesion (p < 0.001), while a history of bypass surgery and stenting appeared to be protective (p < 0.001 for both). Despite these encouraging results, Dr. Whitlow’s group notes that “morbidity and mortality of emergency CABG remain high even in the new millennium.” In this study, 15% of patients requiring emergency CABG for failed PCIs died in the hospital, 12% suffered perioperative Q-wave myocardial infarctions, and 5% had cerebrovascular accidents. Circulation 2002;106:000-000. http://www.circulation.org.