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Abstract
The frequency and outcome of emergency CABG for complications of PTCA in the NHLBI
PTCA Registry were analyzed. Emergency surgery was performed in 202 patients (6.6%).
The most frequent indications for emergency operation were coronary dissection in
46%, coronary occlusion in 20%, prolonged angina in 14% and coronary spasm in 11%.
Emergency surgery was most often necessary in patients in whom lesions could not be
reached or traversed, but more than 25% of patients who required emergency surgery
had initially successful dilatation followed by abrupt reclosure of the vessel. The
mortality rate with emergency CABG was 6.4%, and nonfatal Ml occurred in 41% of patients,
with Q waves developing in approximately 60% of patients with MI. However, 53% of
patients managed with emergency CABG for severe ischemic events with PTCA did not
have evidence of MI or die and had an uncomplicated postoperative course. No baseline
clinical predictors of emergency surgery were identified. Lesion eccentricity was
associated with a significant increase in frequency of emergency operation, and the
incidence of emergency surgery declined with increasing experience with PTCA.
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© 1984 Published by Elsevier Inc.
