Published Online
on October 14, 2002

A more recent version of this article appeared on October 29, 2002

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Submitted on May 24, 2002
Revised on August 20, 2002
Accepted on August 21, 2002

Emergency Coronary Artery Bypass Surgery in the Contemporary Percutaneous Coronary Intervention Era

Niranjan Seshadri MD, Patrick L. Whitlow MD^*, Naveen Acharya MD, Penny Houghtaling MS, Eugene H. Blackstone MD, and Stephen G. Ellis MD

From the Departments of Cardiology (N.S., P.L.W., S.G.E.), Internal Medicine (N.A.), Biostatistics and Epidemiology (P.H., E.H.B.), and Cardiothoracic Surgery (E.H.B.), Cleveland Clinic Foundation, Cleveland, Ohio.

^* To whom correspondence should be addressed. E-mail: whitlop{at}ccf.org.

Background—Since the advent of percutaneous coronary interventions (PCIs), technological advances, adjunctive pharmacotherapy, and increasing operator experience have contributed to lowering the occurrence of major complications. However, emergency coronary artery bypass surgery (CABG) for failed PCI is still associated with important morbidity and mortality, even in the era of coronary stenting. We sought to determine the prevalence, indications, predictors, and complications of emergency CABG after PCI in the past decade.

Methods and Results—We reviewed 18 593 PCIs performed from 1992 through 2000. There was a need for emergency CABG in 113 (0.61%) cases. The major indications were extensive dissection (n=61, 54%), perforation/tamponade (n=23, 20%), and recurrent acute closure (n=23, 20%). Prevalence of emergency CABG decreased from 1.5% of PCIs in 1992 to 0.14% in 2000 (P<0.001). Independent predictors of the need for emergency CABG included the worst ACC/AHA scoring of the intervened lesion (P<0.001) and female sex (P=0.028), whereas history of prior bypass surgery and use of stents resulted in a decreased need for emergency CABG (P<0.001 for both). In patients undergoing emergency CABG, there were 17 (15%) in-hospital deaths, 14 (12%) perioperative Q-wave myocardial infarctions, and 6 (5%) cerebrovascular accidents.

Conclusions—The need for emergency CABG has considerably decreased over time. Risk factors include female sex and a higher ACC/AHA score of the intervened lesion. However, morbidity and mortality of emergency CABG remain high even in the new millennium.

Key words: coronary disease • bypass • grafting • stents • angioplasty

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