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Of 1,315 consecutive patients undergoing PTCA, 9 eventually underwent emergency CABG because of angioplasty failure (emergency rate 0.68%). The indication for emergency bypass was dissection with threatening occlusion in 3 patients, acute occlusion with evolving MI in 3 patients, cardiogenic shock in 1 patient, intractable cardiac arrest in 2 patients. Eight patients were taken directly to the operating room from the catheterization laboratory. The overall mortality of emergency CABG was 11%. One of the two patients with cardiac arrest died of LOS postoperatively. Two patients developed perioperative myocardial infarction (25%). The incidence of operative morbidity and mortality were significantly increased among patients with hemodynamic instability. Should PTCA failure become evident, the prompt undertaking of emergency CABG could perhaps decrease the incidence of acute MI and death.
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T Kinoshita, and
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