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Ann Thorac Surg 1989;47:816-823
© 1989 The Society of Thoracic Surgeons

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Articles

Emergency coronary artery bypass grafting for failed angioplasty: Risk factors and outcome

Divisions of Cardiothoracic Surgery and Cardiology, St. Louis University Medical Center and St. Mary's Health Center, St. Louis, Missouri USA

^_* Address reprint requests to Dr Naunheim, Department of Surgery, St. Louis University Medical Center, 3635 Vista Ave at Grand Blvd, PO Box 15250, St. Louis, MO 63110-0250.

It has been suggested that coronary artery bypass grafting (CABG) performed in the setting of emergent failure of percutaneous transluminal coronary angioplasty causes minimal increased risk compared with routine CABG. We reviewed the records of 103 patients undergoing emergency CABG for failed percutaneous transluminal coronary angioplasty (group 1) and compared them with an identical number of consecutive CABG patients from 1987 (group 2). Group 1 had a lower risk profile evidenced by lower mean age (p < 0.01), fewer diseased vessels (p < 0.0001), better ventricular function (p < 0.001), fewer left main lesions (p < 0.0001), and fewer patients with acute ischemia requiring intravenous administration of nitroglycerin (p < 0.01). Despite these differences, the group 1 patients had a higher mortality rate (11% versus 1%; p < 0.01) and a higher rate of perioperative infarctions (new Q wave) (22% versus 6%; p < 0.01). An analysis of risk factors was performed in the group 1 patients using 36 preoperative and operative variables. Multivariate analysis revealed that left ventricular score (p < 0.0001), preoperative (after percutaneous transluminal coronary angioplasty) need for inotropic support (p < 0.005), and age (p < 0.025) were independent predictors of operative mortality. In conclusion, emergency CABG after failed percutaneous transluminal coronary angioplasty carries a significantly greater risk of operative death and perioperative infarction than elective CABG.

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