CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY
Impact of delays to cardiac surgery after failed angioplasty and stenting
Mat Lotfi, MD*,
Karen Mackie, RN*,
Vladimir Dzavik, MD* and
Peter H. Seidelin, MD*,*
* 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.
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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 |
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