Emergency coronary artery bypass grafting following failed percutaneous coronary angioplasty - Early and late results after operation

In recent years the equipment and techniques for percutaneous transluminal coronary angioplasty (PTCA) have been improved and today complex and distal stenoses are also treated in this way. Subsequent to failed PTCA some patients undergo emergency CABG. Between January 1991 and March 1995 3520 patients have been treated by PTCA in our hospital. 61 patients (1.7 %), mean age 61.1 years, underwent subsequent emergency CABG after PTCA. 46 % had single-, 33 % double and 21 % had triple-vessel-disease, the mean left ventricular function (LVEF) was 65 %. The mean number of bypass grafts was 1.9. The internal mammary arteries were never used under these emergency conditions. 9 patients (15 %) developed perioperative myocardial infarction and in two of them the LVEF decreased under 30 %. The hospital mortality was 6.6 % (= 4 perioperative deaths). 6 of 61 patients were lost for follow-up; 90 % of the hospital survivors were followed for 244 months (mean 17). During this period there were 4 late deaths (3 cardiac and 1 non-cardiac). Actuarial survival at one year was 90 %. 80 % of the long-term survivors were in the NYHA functional classes I and II. In patients with double- or triple-vessel-disease PTCA almost always effects an incomplete revascularisation. Emergency CABG following failed PTCA is associated with an increased mortality and morbidity. The long-term prognosis is similar to that of an age-sex matched general population.