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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Emergency Coronary Artery Bypass Surgery for Percutaneous Coronary Interventions

Changes in the Incidence, Clinical Characteristics, and Indications From 1979 to 2003

Eric H. Yang, MD^_*, Richard J. Gumina, MD, PhD^_*, Ryan J. Lennon, MS, David R. Holmes, Jr, MD^_*, Charanjit S. Rihal, MD^_* and Mandeep Singh, MD^_*,_*

^_* Division of Cardiovascular Disease and Internal Medicine, Mayo College of Medicine, Rochester, Minnesota
Division of Biostatistics, Mayo College of Medicine, Rochester, Minnesota

Manuscript received April 11, 2005; revised manuscript received June 10, 2005, accepted June 20, 2005.

^_* Reprint requests and correspondence: Dr. Mandeep Singh, Division of Cardiovascular Disease and Internal Medicine, Mayo College of Medicine, 200 First Street SW, Rochester, Minnesota 55905. (Email: singh.mandeep{at}mayo.edu).

OBJECTIVES: The purpose of the current study was to evaluate the changes in incidence, clinical characteristics, and indications for emergency coronary artery bypass grafting (CABG) in patients undergoing percutaneous coronary intervention (PCI) from 1979 to 2003.

BACKGROUND: Emergency CABG after PCI is associated with significant morbidity and mortality.

METHODS: Data from 23,087 patients who underwent PCI at Mayo Clinic from 1979 to 2003 were analyzed. Patients were divided into three groups: the "pre-stent" era, 1979 to 1994 (n = 8,905); the "initial stent era," 1995 to 1999 (n = 7,605); and the "current stent era," 2000 to 2003 (n = 6,577).

RESULTS: Although patients undergoing PCI in the recent time periods had more high-risk features, there was a significant decrease in the incidence of emergency CABG from 2.9% to 0.7% to 0.3% across the groups (p < 0.001). Patients requiring emergency surgery in the recent time periods had a higher prevalence of hypertension, prior revascularization, and left ventricular dysfunction (ejection fraction <40%), as well as more complex coronary lesions. Fewer patients in the current stent era had coronary artery dissections and abrupt vessel closure requiring emergency CABG. The in-hospital mortality rate for emergency CABG patients remains unchanged and ranges from 10% to 14%.

CONCLUSIONS: The current study demonstrates that despite the increase in high-risk patients undergoing PCI, there has been a marked decrease in the incidence of patients requiring emergency CABG. However, the in-hospital mortality rate for those requiring emergency CABG remains high and unchanged.

Abbreviations and Acronyms   ACC/AHA = American College of Cardiology/American Heart Association   CABG = coronary artery bypass grafting   CCS = Canadian Cardiovascular Society   PCI = percutaneous coronary intervention

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