HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lotfi, M. Articles by Seidelin, P. H. Search for Related Content PubMed PubMed Citation Articles by Lotfi, M. Articles by Seidelin, P. H.

CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Impact of delays to cardiac surgery after failed angioplasty and stenting

^* Division of Cardiology, Department of Medicine, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Canada

Manuscript received May 27, 2003; revised manuscript received July 30, 2003, accepted August 5, 2003.

^* Reprint requests and correspondence: Dr. Peter H. Seidelin, Assistant Professor of Medicine, Director, Cardiac Intensive Care Unit, University Health Network, Toronto General Hospital, 200 Elizabeth Street, EN 12-238, Toronto, Ontario M5G 2C4, Canada.
peter.seidelin{at}uhn.on.ca

OBJECTIVES: This study was designed to determine the likelihood of harm in patients having additional delays before urgent coronary artery bypass graft (UCABG) surgery after percutaneous coronary intervention (PCI).

BACKGROUND: Patients who have PCI at hospitals without cardiac surgery have additional delays to surgery when UCABG is indicated.

METHODS: Detailed chart review was performed on all patients who had a failed PCI leading to UCABG at a large tertiary care hospital. A prespecified set of criteria (hemodynamic instability, coronary perforation with significant effusion or tamponade, or severe ischemia) was used to identify patients who would have an increased likelihood of harm with additional delays to surgery.

RESULTS: From 1996 to 2000, 6,582 PCIs were performed. There were 45 patients (0.7%) identified to have UCABG. The demographic characteristics of the UCABG patients were similar to the rest of the patients in the PCI database, except for significantly more type C lesions (45.3% vs. 25.0%, p < 0.001) and more urgent cases (66.6% vs. 49.8%, p = 0.03) in patients with UCABG. Myocardial infarction occurred in eight patients (17.0%) after UCABG, with a mean peak creatine kinase of 2,445 ± 1,212 IU/l. Death during the index hospital admission occurred in two patients. Eleven of the 45 patients (24.4%) were identified by the prespecified criteria to be at high likelihood of harm with additional delays to surgery. The absolute risk of harm is approximately one to two patients per 1,000 PCIs.

CONCLUSIONS: Approximately one in four patients referred for UCABG would be placed at increased risk of harm if delays to surgery were encountered.

Abbreviations and Acronyms   ACC = American College of Cardiology   AHA = American Heart Association   AMI = acute myocardial infarction   CK = creatine kinase   ECG = electrocardiographic   MI = myocardial infarction   NCDR = National Cardiovascular Data Registry   PCI = percutaneous coronary intervention   UCABG = urgent coronary artery bypass graft

This article has been cited by other articles:

				D. C. Brown, S. Szabo, T. Oikonomopoulos, H. M. Hoffmeister, A. S. Kashyap, S. Kashyap, K. P. Anand, E. C. Keeley, and L. D. Hillis Primary percutaneous coronary intervention. N. Engl. J. Med., April 12, 2007; 356(15): 1588 - 1589. [Full Text] [PDF]

				H. H. Ting, G. Raveendran, R. J. Lennon, K. H. Long, M. Singh, D. L. Wood, B. J. Gersh, C. S. Rihal, and D. R. Holmes Jr A Total of 1,007 Percutaneous Coronary Interventions Without Onsite Cardiac Surgery: Acute and Long-Term Outcomes J. Am. Coll. Cardiol., April 18, 2006; 47(8): 1713 - 1721. [Abstract] [Full Text] [PDF]

				T. P. Wharton Jr, E. C. Keeley, C. L. Grines, T. P. Wharton Jr, E. C. Keeley, and C. L. Grines The Case for Community Hospital Angioplasty Circulation, November 29, 2005; 112(22): 3509 - 3534. [Full Text] [PDF]

				D. L. Connolly, G. Y.H. Lip, and T. S.N. Lo Pushing the envelope too far? J. Am. Coll. Cardiol., November 16, 2004; 44(10): 2094 - 2095. [Full Text] [PDF]

				M. Lotfi and P. H. Seidelin Reply J. Am. Coll. Cardiol., November 16, 2004; 44(10): 2095 - 2096. [Full Text] [PDF]

				R. Gubner and W. Rowe Impact of delays to cardiac surgery J. Am. Coll. Cardiol., November 16, 2004; 44(10): 2094 - 2094. [Full Text] [PDF]

				G. J. Dehmer and D. S. Gantt Reply J. Am. Coll. Cardiol., November 16, 2004; 44(10): 2095 - 2095. [Full Text] [PDF]

				Writing Committee Members, E. M. Antman, D. T. Anbe, P. W. Armstrong, E. R. Bates, L. A. Green, M. Hand, J. S. Hochman, H. M. Krumholz, F. G. Kushner, et al. ACC/AHA guidelines for the management of patients with ST-Elevation myocardial infarction--executive summary: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (writing committee to revise the 1999 guidelines for the management of patients with acute myocardial infarction) J. Am. Coll. Cardiol., August 4, 2004; 44(3): 671 - 719. [Full Text] [PDF]

				E. M. Antman, D. T. Anbe, P. W. Armstrong, E. R. Bates, L. A. Green, M. Hand, J. S. Hochman, H. M. Krumholz, F. G. Kushner, G. A. Lamas, et al. ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction) Circulation, August 3, 2004; 110(5): 588 - 636. [Full Text] [PDF]

				Delays to CABG After Failed PCI: What Are the Risks? Journal Watch Cardiology, April 2, 2004; 2004(402): 1 - 1. [Full Text]