HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Nan Wang Steven R. Gundry Glen Van Arsdell Anees J. Razzouk Edwin E. Vyhmeister Leonard L. Bailey Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wang, N. Articles by Bailey, L. L. Search for Related Content PubMed PubMed Citation Articles by Wang, N. Articles by Bailey, L. L.

J Thorac Cardiovasc Surg 1995;110:214-223
© 1995 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

Percurtaneous transluminal coronary angioplasty failures in patients with multivessel diseaseIs there an increased risk?

Loma Linda, Calif.

From the Division of Cardiothoracic Surgery, Department of Surgery, Loma Linda University Medical Center, Loma Linda, Calif.

Address for reprints: Nan Wang, MD, Assistant Professor of Surgery, Division of Cardiothoracic Surgery, Loma Linda University Medical Center, Department of Surgery, 11234 Anderson St., Loma Linda, CA 92354.

Abstract

In recent years, there has been a nationwide trend toward performing percutaneous transluminal coronary angioplasty in patients with multivessel coronary artery disease. The clinical course of 57 consecutive patients who required emergency first-time coronary artery bypass grafting operations were reviewed to assess for difference in outcome between the 28 patients (49%) with single-vessel disease and the 29 patients (51%) with multivessel disease. The two groups were similar in preoperative characteristics except for a higher proportion of chronic obstructive pulmonary disease in the patients with multivessel disease (p = 0.03). Twice as many patients with multivessel disease were in shock (single-vessel disease = 4 [14%], multivessel disease = 8 [28%], p = not significant) en route to the operating room and significantly more patients with multivessel disease required on-going cardiopulmonary resuscitation (single-vessel disease = 0 [0%], multivessel disease = 5 [17%], p = 0.03). Significantly more coronary artery bypass grafts were placed in the patients with multivessel disease (single-vessel disease = 1.5±0.6, multivessel disease = 2.9±0.7, p < 0.01), which required longer aortic clamping time (p = 0.02) and cardiopulmonary bypass time (p < 0.01). There were seven postoperative deaths; all but one occurred in patients with multivessel disease (single-vessel disease = 1 [4%], multivessel disease = 6 [21%], p = 0.05). According to multivariate analysis, incremental risk factors of mortality were preoperative shock (p < 0.01), urgent or emergency percutaneous transluminal coronary angioplasty (p = 0.06), and multivessel disease (p = 0.12). Despite a similar incidence of myocardial infarction (single-vessel disease = 8 [29%], multivessel disease = 12 [41%], p = not significant), patients with multivessel disease had a higher incidence of cardiac morbidity (single-vessel disease = 4 [14%], multivessel disease = 11 [38%], p = 0.04) and noncardiac morbidity (single-vessel disease = 4 [14%], multivessel disease = 12 [41%], p = 0.02). By multivariate analysis, incremental risk factors of morbidity were preoperative shock (p < 0.01), multivessel disease (p = 0.02), and ejection fraction < 50% (p = 0.07). In the subset of patients with multivessel disease, preoperative shock, ejection fraction < 50, and an age of 60 years or greater were associated with higher morbidity and mortality. In conclusion, the risk of percutaneous transluminal coronary angioplasty failure is considerably higher in patients with multivessel disease. In certain subsets of patients with multivessel disease, coronary artery bypass grafting would be a safer procedure when compared with percutaneous transluminal coronary angioplasty for initial myocardial revascularization. (J THORACCARDIOVASCSURG1995;110:214-23)

This article has been cited by other articles:

				H. L. Lazar, A. K. Jacobs, G. S. Aldea, O. M. Shapira, D. Lancaster, and R. J. Shemin Factors Influencing Mortality After Emergency Coronary Artery Bypass Grafting for Failed Percutaneous Transluminal Coronary Angioplasty Ann. Thorac. Surg., December 1, 1997; 64(6): 1747 - 1752. [Abstract] [Full Text]