Premium
Emergency coronary artery bypass surgery following coronary angioplasty and stenting: Results of a French multicenter registry
Author(s) -
Loubeyre Christophe,
Morice MarieClaude,
Berzin Bernard,
Virot Patrice,
Commeau Philippe,
Drobinski Gérard,
Ethevenot Gérard,
Moquet Benoît,
Marco Jean,
Labrunie Pierre,
Cattan Simon,
Coste Pierre,
Aubry Pierre,
Ferrier Alain
Publication year - 1999
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/(sici)1522-726x(199908)47:4<441::aid-ccd12>3.0.co;2-s
Subject(s) - medicine , angioplasty , bypass surgery , coronary artery bypass surgery , myocardial infarction , emergency surgery , incidence (geometry) , surgery , percutaneous transluminal coronary angioplasty , stent , interventional cardiology , artery , cardiology , physics , optics
This study investigates the influence of coronary stenting on the risk of emergency bypass surgery performed within 24 hr of percutaneous tranluminal coronary angioplasty (PTCA) with particular concern for incidence and indication. Since 1995, coronary stenting has been increasingly performed in France during angioplasty procedures, altering significantly the role of emergency bypass surgery. The outcome of elective stenting and widespread use of coronary stenting and its influence on emergency surgery have not been evaluated so far. Through a retrospective (1995) and prospective (1996) registry, we analyzed the incidence, indication and results of emergency bypass surgery performed within 24 hr of PTCA in 68 and 57 centers, respectively, accounting for nearly half of all angioplasty procedures in France. Data were collected through questionnaires consisting of separate forms for every case report that were sent to every center. Over the two years, 26,885 and 27,497 procedures were investigated with a stenting rate of 46% and 64%, respectively. The observed need for emergency surgery was constantly low throughout this period (0.38% and 0.32%, respectively). Indications for surgery included complications directly due to stent in 37% of cases in the 2‐year period. Outcome remained poor, with in‐hospital mortality in 10% and 17% and myocardial infarction in 27% and 25% of cases, respectively. A comparison of the results in centers with and without surgical facilities showed no differences in outcome, despite a longer time to surgery (359 min ± 406 min vs. 170 min ± 205 min, P = 0.0001) and a lower incidence of emergency surgery (0.25% vs. 0.44%, P = 0.0001) in centers without on‐site surgery backup. The French multicenter registry reveals an increase in the use of stents together with a dramatic decrease in the incidence of emergency bypass surgery (below 0.5 %) following PTCA. There has been a significant evolution in the indication, and stent implantation now accounts for a third of the indications for emergency bypass surgery. Cathet. Cardiovasc. Intervent. 48:441–448, 1999. © 1999 Wiley‐Liss, Inc.