Emergency operation after failed angioplasty.

A group of patients with failed angioplasty who then required emergency coronary bypass was compared with a historically matched group of patients who had had elective bypass grafting. The two groups were well matched in age, sex, ejection fraction, and New York Heart Association classification and in the incidence of diabetes and hypertension. Significant differences were found in the prevalence of mortality (12% versus 1.5%), hemorrhage (28% versus 13%), cardiac tamponade (10.5% versus 1.5%), myocardial infarction (28% versus 9%), and length of hospital stay (15.3 days versus 13.4 days). Cardiogenic shock carries the worst prognosis; four of the five patients with this condition died. Because emergency operation after failed angioplasty carries with it significant postoperative morbidity and mortality, this procedure cannot be considered equivalent to elective coronary bypass grafting.