Coronary artery bypass surgery after failed elective percutaneous transluminal coronary angioplasty. A status report.

This study was performed to determine the procedural characteristics and in-hospital complications associated with failed percutaneous transluminal coronary angioplasty that necessitates coronary artery bypass graft surgery. The study population consisted of 316 patients from 1980 to 1986; 202 patients (64%) had emergency coronary artery bypass graft surgery and the remainder elective surgery during the same hospitalization. Mean age of the population was 56 +/- 9 years, 69% were male, and 69% had single-vessel disease. The failed percutaneous transluminal coronary angioplasty occurred most commonly on the first vessel attempted and was usually secondary to coronary artery dissection. Analysis of surgical technique revealed increased use of intra-aortic balloon pump in the emergency group (24% vs. 2% in the elective group, p less than 0.05). Overall, 2.0 +/- 1.0 (mean +/- SD) bypass grafts were placed, with increased use of the internal thoracic artery in the elective (32%) versus the emergency group (20%, p less than 0.05). A new, nonfatal, postprocedural Q-wave myocardial infarction occurred in 18% and developed more frequently in the emergency (27%) than in the elective (4%) cohorts. There were six in-hospital deaths (1.9%), an incidence which did not differ between groups. This analysis revealed a significant difference in operative technique between the emergency and the elective coronary artery bypass graft patients. Preoperative ischemia was significantly related to the development of the Q-wave myocardial infarction, yet not to in-hospital mortality.(ABSTRACT TRUNCATED AT 250 WORDS)