Ann Thorac Surg 2006;81:1665
© 2006 The Society of Thoracic Surgeons
Original article: Cardiovascular
Invited commentary
Hendrick B. Barner, MD
Division of Cardiothoracic Surgery, Washington University, 6125 Clayton Ave, Suite 430, St. Louis, MO 63139
(Email: hendrick.barner{at}forestparkhospital.com).
The success of percutaneous coronary interventions has been incrementally improved by new antiplatelet drugs and bare-metal stents with a reduction in emergency coronary artery bypass despite extending interventions to patients with increasingly complex disease who are at greater risk for morbidity and mortality after the operation.
The decrease in the need for emergent surgical intervention after percutaneous coronary intervention from 2.9% to 0.8% of bypass procedures has been partially offset numerically by the increasing frequency of percutaneous interventions. Postoperative morbidity has climbed during this 10-year interval, particularly in those with myocardial infarction in the 24 hours preceding intervention. Mortality has also risen in this high-risk group, whereas in the no myocardial infarction group it has actually somewhat decreased after peaking in the middle years of this analysis.
The advent of drug-eluting stents has not impacted these data presented [1], but they will accelerate the trend to reduce the need for coronary artery bypass and thereby increase the proportion of bypass procedures done emergently. The percent of percutaneous coronary intervention patients requiring coronary bypass is not likely to change as a result of drug-eluting stents per se, but could be influenced negatively by extending the technology to patients with increasingly complex disease or positively by improving technology, operator skill, and patient selection.
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- Haan CK, O'Brien S, Edwards FH, Peterson ED, Ferguson TB. Trends in emergency coronary artery bypass grafting after percutaneous coronary intervention, 1994-2003 Ann Thorac Surg 2006;81:1658-1665.[Abstract/Free Full Text]
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