Analysis of 100 Emergency Aortocoronary Bypass Operations After Percutaneous Transluminal Coronary Angioplasty: Which Patients are at Risk for Large Infarctions?

  • H. KlepzigJr.
  • G. Kober
  • P. Satter
  • M. Kaltenbach

Abstract

Severe vascular complications are an inherent risk of per-cutaneous transluminal coronary angioplasty (PTCA). The data of the first 100 emergency aortocoronary bypass operations required in the first 2850 interventions (3.5%) were retrospectively analyzed in order to identify factors that determine postoperative infarct size. Large infarctions were assumed if the patient died of cardiogenic shock (n = 12), if postoperative angiography demonstrated a decrease in left ventricular ejection fraction by more than 20% or if R-waves in the ECG decreased by more than 40% and a QRS-score increased by more than 5.

According to these definitions, 29 patients experienced large infarctions, 71 no or only small infarctions. The following factors differentiated the two groups: age (58 vs 53 years, p = 0.008), pre-PTCA exercise work load (88 vs 118 Watt, p = 0.0001), exercise ischemia score (2.7 vs 1.9, p = 0.045), degree of pre-PTCA stenosis (83 vs 86%, p = 0.03), coronary multivessel versus single vessel disease (60 vs 38%, p = 0.02), collaterals to the target vessel (10 vs 34%, p = 0.05), total vascular occlusion during PTCA (76 vs 56%, p = 0.035), and long duration of ischemia after onset of the complication (253 vs 179 min, p =0.012). The data of patients with large postoperative infarctions who survived ranged between those with no or small infarctions and those who died of cardiogenic shock. Higher age (p = 0.04), reduced exercise tolerance (p = 0.0004), absence of collaterals (p = 0.04), and duration of ischemia until reperfusion (p = 0.001) were independent predictors of large postoperative myocardial infarctions.

It is concluded that when complications occur during PTCA, a specific subgroup of patients, i.e. especially patients with reduced exercise tolerance and no visible collaterals to the target vessel, has an increased risk of developing large postoperative myocardial infarctions. In these patients, immediate surgical support should be available.

Key words

Percutaneous transIuminal coronary angioplasty Emergency aortocoronary bypass operation Mvocardial infarction Mortality 

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Copyright information

© Springer-Verlag Berlin Heidelberg 1990

Authors and Affiliations

  • H. KlepzigJr.
  • G. Kober
  • P. Satter
  • M. Kaltenbach

There are no affiliations available

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