| Emergency coronary artery bypass surgery for failed percutaneous coronary angioplasty. A 10-year experience. | |
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MedLine Citation:
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PMID: 1616379 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Six hundred ninety-nine patients have required emergency coronary artery bypass after failed elective percutaneous coronary angioplasty during the decade September 1980 through December 1990. This represents 4% of 9860 patients having 12,146 elective percutaneous coronary angioplasty procedures during this interval. Emergency coronary artery bypass was required for acute refractory myocardial ischemia in 82%. Hospital mortality rate for all patients was 3.1%; 3.7% in patients with refractory myocardial ischemia but 0.8% in patients without refractory myocardial ischemia, p = 0.08. Postprocedural Q-wave myocardial infarctions were observed in 21% versus 2.4%, p less than 0.0001, and intra-aortic balloon pumping was required in 19% with versus 0.8% without refractory myocardial ischemia, p less than 0.0001. Multivessel disease, p = 0.004, age older than 65 years, p = 0.005, and refractory myocardial ischemia, p = 0.08, interacted to produce the highest risk of in-hospital death. Follow-up shows that there have been 28 additional late deaths, including 23 of cardiac causes for a 91% survival at 5 years. Freedom from both late death and Q-wave myocardial infarction at 5 years was 61%. In the group going to emergency coronary artery bypass with refractory myocardial ischemia, the late cardiac survival was 90%, and in those without ischemia, 92% at 5 years, p = not significant. The MI--free survival in the group with refractory ischemia, however, was 56% versus 83% in the group without ischemia, p less than 0.0001. Multivariate analysis showed the highest late event rates for patients with Q-wave myocardial infarction at the initial emergency coronary artery bypass, age older than 65 years, angina class III or IV, and prior coronary bypass surgery. In spite of a continuing high incidence of early acute myocardial infarction and an increasing operative mortality rate (7%) in the latest 3 years cohort of patients, excellent late survival and low subsequent cardiac event rates demonstrate the lasting effectiveness of prompt, successful emergency coronary bypass surgery for failed percutaneous coronary angioplasty. |
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Authors:
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J M Craver; W S Weintraub; E L Jones; R A Guyton; C R Hatcher |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Annals of surgery Volume: 215 ISSN: 0003-4932 ISO Abbreviation: Ann. Surg. Publication Date: 1992 May |
Date Detail:
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Created Date: 1992-07-30 Completed Date: 1992-07-30 Revised Date: 2009-11-18 |
Medline Journal Info:
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Nlm Unique ID: 0372354 Medline TA: Ann Surg Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 425-33; discussion 433-4 Citation Subset: AIM; IM |
Affiliation:
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Joseph B. Whitehead Department of Surgery, Emory University School of Medicine, Atlanta, Georgia. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Actuarial Analysis Angioplasty, Transluminal, Percutaneous Coronary* Coronary Artery Bypass* / mortality Coronary Disease / mortality, surgery* Emergencies Female Follow-Up Studies Hospital Mortality Humans Incidence Intra-Aortic Balloon Pumping / utilization Male Middle Aged Myocardial Infarction / epidemiology Risk Factors Time Factors |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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