Emergency Coronary-Artery Surgery After Percutaneous Transluminal Coronary Angioplasty - Immediate Results And Long-Term Outcome In 100 Cases

The increasing application of percutaneous transluminal coronary angioplasty (PTCA) requires evaluation of emergency coronary artery surgery for complications of this procedure.In a consecutive series of 2 576 angioplasties performed between April 1980 and January 1990, 100 patients (82 men and 18 women, average age 54 +/- 10 years, 3.9%) underwent emergency coronary artery surgery because of complications. The artery involved was the left anterior descending artery in 81 % of cases. The causal lesion was a dissection and/or thrombus in 95 % of cases; 85 % of patients were referred for surgery with acute myocardial infarction. The average delay before surgery was 110 +/- 15 minutes (interval between coronary occlusion and starting cardiopulmonary bypass) and 155 coronary grafts were implanted (1.5 per patient).The hospital mortality was 19 %; the infarction rate was 57 %. The left ventricular ejection fraction decreased from 63 +/- 10 % (preoperatively) to 52 +/- 9 % (postoperatively), p < 0.001.Hospital mortality was significantly related to three factors, old age, unstable angina before PTCA, and cardiogenic shock or the necessity for external cardiac massage. In the subgroup of patients developing cardiogenic shock (n = 7) or requiring external cardiac massage during transfer to the operating theatre (n = 16) the mortality was 44 %.Among the 81 survivors, the global 7 year survival rate was 96 % (Kaplan-Meier) with 3 cardiac deaths, 2 other patients developing myocardial infarction and 4 undergoing repeat angioplasty. After an average follow-up of 55 +/- 38 months, 80 % of patients are asymptomatic, 34 % have no antianginal drugs and 73 % of those who were previously employed have returned to work. The 13 patients operated in cardiogenic shock or requiring external cardiac massage, and who survived surgery, are still alive.Despite a high hospital mortality, over half the patients referred with cardiogenic shock survived surgery. In addition, after the initial postoperative period, their long-term prognosis seems to be satisfactory.