Coronary artery bypass grafting after failed percutaneous angioplasty compared to direct coronary bypass grafting in patients with unstable angina

With the increasing experience in percutaneous transluminal angioplasty (PTCA) for unstable angina surgical revascularization versus interventional angioplasty treatment has been controversial. From 1991 to 1993, 162 patients underwent coronary artery bypass grafting (CABG) for unstable angina. While 126 patients received primary surgery (group 1), 36 had a PTCA first which was followed by emergency operation for complications (group II). In group II there were more cases of single-or double-vessel disease (p < 0.001) and none had left main stem stenosis (p < 0.0001), but there was no difference in ventricular function between the groups. The number of distal anastomoses, mean cross-clamp time, and usage of the internal mammary artery (IMA) were significantly lower in group II. The perioperative mortality rate was comparable between groups (5.5 % versus 8.3%; n.s.). Myocardial infarction occurred more frequently in patients after PTCA (8.3% versus 4.0%: p < 0.05) without increasing the rate of low output syndrome. In conclusion, emergency CABG after failed PTCA in patients with unstable angina carries an acceptable perioperative risk. Since the perioperative rate of myocardial infarction is higher and the IMA is used less frequently in this setting long-term results may be better with the direct surgical approach.