Darwazah A K, Islim I, Hanbali B, Shama R A, Aloul J
Department of Cardiac Surgery, Jerusalem, Israel2 Department of Cardiology, Makassed Hospital, Jerusalem, Israel.
J Cardiovasc Surg (Torino). 2009 Dec;50(6):795-800.
The incidence of patients subjected to emergency coronary artery bypass graft (CABG) after percutaneous coronary intervention (PCI) is decreasing due to improvement of PCI technique and device technology. The aim of our study is to evaluate cases subjected to emergency CABG after complicated PCI to determine incidence, indications and results of surgery and to compare them with other emergency cases which are not related to angioplasty or stenting.
From April 1999 to December 2005, 1 200 patients who underwent PCI were analysed. Those patients who developed complications related to PCI and required surgical intervention were included (PCI group N.=31). These patients were compared with other emergency cases not related to PCI (non-PCI group N.=48). The selection of these patients was based on the criteria of the Society of Thoracic Surgeons.
The incidence of PCI complications which necessitated emergency surgical intervention was 2.6%. The main indication was due to unsatisfactory angioplasty with ongoing myocardial ischemia (68%), stent thrombosis (13%), dissection (10%) retained angioplasty wire (6.5%), and perforation (3%). The incidence of cardiogenic shock, ongoing ischemia, acute infarction <24 h and the use of intra-aortic balloon pumps were similar among both groups. But the incidence of preoperative cardiac arrest was more in PCI patients (41.9% vs 22.9%, P=0.07). The timing of surgical intervention after termination of PCI varied from immediate transfer to 12 h (mean 3.4+/-3) while, in the non-PCI patients, the time was from 5-24 h (mean 13.3+/-6). Completeness of revascularization was similar among both groups. However, the mean number of grafts per patient was more in non-PCI group (2.4+/-0.9 vs 2.0+/-0.8, P=0.25). In-hospital mortality was 12.9% among PCI patients in comparison to 10.4% in non-PCI group (P=0.73). The combined incidence of major postoperative morbidity was more among PCI patients. Nevertheless, the difference was not significant except for acute renal failure.
Emergency coronary artery bypass grafting among patients with PCI complications and those patients not related to PCI is associated with high mortality and morbidity. Although, the percentage of mortality and morbidity was more among PCI patients the difference between both groups was not significant. Surgical backup and collaboration between cardiologist and surgeons is needed to reduce delay in management and patients transfer to obtain the best surgical outcome.
由于经皮冠状动脉介入治疗（PCI）技术和设备技术的改进，PCI术后接受急诊冠状动脉旁路移植术（CABG）的患者发生率正在下降。我们研究的目的是评估复杂PCI术后接受急诊CABG的病例，以确定手术的发生率、适应证和结果，并将其与其他与血管成形术或支架置入无关的急诊病例进行比较。
对1999年4月至2005年12月期间接受PCI的1200例患者进行分析。纳入那些发生与PCI相关并发症并需要手术干预的患者（PCI组，n = 31）。将这些患者与其他与PCI无关的急诊病例（非PCI组，n = 48）进行比较。这些患者的选择基于胸外科医师协会的标准。
需要急诊手术干预的PCI并发症发生率为2.6%。主要适应证为血管成形术效果不佳伴持续心肌缺血（68%）、支架血栓形成（13%）、夹层（10%）、残留血管成形术导丝（6.5%）和穿孔（3%）。两组的心源性休克、持续缺血、急性梗死<24小时以及主动脉内球囊泵的使用发生率相似。但PCI患者术前心脏骤停的发生率更高（41.9%对22.9%，P = 0.07）。PCI终止后手术干预的时间从立即转运到12小时不等（平均3.4±3），而非PCI患者的时间为5 - 24小时（平均13.3±6）。两组血管重建的完整性相似。然而，非PCI组每位患者的平均移植血管数量更多（2.4±0.9对2.0±0.8，P = 0.25）。PCI患者的院内死亡率为12.9%，而非PCI组为10.4%（P = 0.73）。PCI患者术后主要并发症的合并发生率更高。然而，除急性肾衰竭外，差异无统计学意义。
PCI并发症患者和与PCI无关的患者进行急诊冠状动脉旁路移植术均伴有高死亡率和高发病率。虽然PCI患者的死亡率和发病率百分比更高，但两组之间的差异无统计学意义。需要心脏科医生和外科医生之间的手术支持与协作，以减少管理延误和患者转运，从而获得最佳手术结果。
