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Coronary artery bypass grafting after iatrogenic coronary artery dissection: A single center eight years' experience. COR ET VASA 2023. [DOI: 10.33678/cor.2022.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Thielmann M, Wendt D, Slottosch I, Welp H, Schiller W, Tsagakis K, Schmack B, Weymann A, Martens S, Neuhäuser M, Wahlers T, Choi YH, Ruhparwar A, Liakopoulos OJ. Coronary Artery Bypass Graft Surgery in Patients With Acute Coronary Syndromes After Primary Percutaneous Coronary Intervention: A Current Report From the North-Rhine Westphalia Surgical Myocardial Infarction Registry. J Am Heart Assoc 2021; 10:e021182. [PMID: 34514809 PMCID: PMC8649544 DOI: 10.1161/jaha.121.021182] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Coronary artery bypass grafting has remained an important treatment option for acute coronary syndromes, particularly in patients (1) with ongoing ischemia and large areas of jeopardized myocardium, if percutaneous coronary intervention (PCI) cannot be performed; (2) following successful PCI of the culprit lesion with further indication for coronary artery bypass grafting; and (3) where PCI is incomplete, not sufficient, or failed. Methods and Results We aimed to analyze coronary artery bypass grafting outcome following prior PCI in acute coronary syndromes from the North-Rhine-Westphalia surgical myocardial infarction registry comprising 2616 patients. Primary end points were in-hospital all-cause mortality and major adverse cardio-cerebral event. Patients were 68±11 years of age, had 3-vessel and left main-stem disease in 80.4% and 45.3%, presenting a logistic EuroSCORE of 15.1% in unstable angina, 20.3% in non-ST-segment-elevation myocardial infarction, and 23.5% in ST-segment-elevation myocardial infarction. A history of PCI was present in 36.2% and PCI was performed within 24 hours before surgery in 5.2% in unstable angina, 5.9% in non-ST-segment-elevation myocardial infarction, and 16.1% in ST-segment-elevation myocardial infarction. PCI failed in 5.3% in unstable angina, 6.8% in non-ST-segment-elevation myocardial infarction and 17.2% in ST-segment-elevation myocardial infarction, and 28.8% of patients presented with cardiogenic shock. In-hospital mortality without PCI was 7.4%, but increased to 8.7% with prior PCI >24 hours, 14.5% with prior PCI <24 hours, and 14.1% with failed PCI (P<0.003). The in-hospital major adverse cardio-cerebral event rate was 16.4% without PCI, but 17.4% with prior PCI >24 hours, 25.6% with prior PCI <24 hours, and 41.3% with failed PCI (P=0.014). Multivariable logistic regression analysis showed prior PCI (P=0.039), as well as failed PCI (P=0.001) to be predictors for in-hospital all-cause mortality and major adverse cardio-cerebral event. Conclusions In the current PCI era, immediately prior or failed PCI before coronary artery bypass grafting in acute coronary syndromes is associated with high perioperative risk, cardiogenic shock, and increased morbidity and mortality.
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Affiliation(s)
- Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery West-German Heart and Vascular Center University of Duisburg-Essen Essen Germany
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery West-German Heart and Vascular Center University of Duisburg-Essen Essen Germany
| | - Ingo Slottosch
- Department of Cardiothoracic Surgery University-Hospital of Cologne Cologne Germany
| | - Henryk Welp
- Department of Cardiac Surgery University Hospital Münster Münster Germany
| | | | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery West-German Heart and Vascular Center University of Duisburg-Essen Essen Germany
| | - Bastian Schmack
- Department of Thoracic and Cardiovascular Surgery West-German Heart and Vascular Center University of Duisburg-Essen Essen Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery West-German Heart and Vascular Center University of Duisburg-Essen Essen Germany
| | - Sven Martens
- Department of Cardiac Surgery University Hospital Münster Münster Germany
| | - Markus Neuhäuser
- Department of Mathematics and Technique Koblenz University of Applied Science Remagen Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery University-Hospital of Cologne Cologne Germany
| | - Yeong-Hoon Choi
- Department of Cardiothoracic Surgery University-Hospital of Cologne Cologne Germany.,Department of Cardiac Surgery Campus Kerckhoff University of Giessen Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery West-German Heart and Vascular Center University of Duisburg-Essen Essen Germany
| | - Oliver-J Liakopoulos
- Department of Cardiothoracic Surgery University-Hospital of Cologne Cologne Germany.,Department of Cardiac Surgery Campus Kerckhoff University of Giessen Germany
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Verevkin A, von Aspern K, Leontyev S, Lehmann S, Borger MA, Davierwala PM. Early and Long-Term Outcomes in Patients Undergoing Cardiac Surgery Following Iatrogenic Injuries During Percutaneous Coronary Intervention. J Am Heart Assoc 2020; 8:e010940. [PMID: 30612504 PMCID: PMC6405713 DOI: 10.1161/jaha.118.010940] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Iatrogenic coronary artery injuries during percutaneous coronary interventions (PCI) often require emergent surgical management. Our study evaluated the early and long‐term outcomes in patients undergoing surgical treatment of iatrogenic PCI complications and identified the predictors of operative and long‐term mortality. Methods and Results Pre‐, intra‐ and post‐operative data and hospital outcomes of 168 consecutive patients undergoing cardiac surgical procedures for iatrogenic complications following PCI between December 1999 and July 2015, were prospectively collected in our computerized database. Logistic and Cox regression analyses were used to identify the independent predictors of operative and long‐term mortality. The mean age was 68.5±10.2 years and 35.7% were females. PCI complications included left anterior descending (38.7%), right coronary (29.2%), circumflex (13.1%), left main coronary artery injuries (19.0%), and acute myocardial infarction (66.7%), Type A aortic dissection (7.7%), cardiac tamponade (17.9%), and cardiogenic shock (CS) (46.4%). Operative mortality for corrective surgery was 20.8% and was independently predicted by critical preoperative state (odds ratio: 3.5; P=0.01). The 5‐ and 10‐year survival for all patients was 63.9±4.0% and 49.6±5.0%, which improved remarkably in hospital survivors (79.0±4.0% and 64.0±6.0%). Risk factors for long‐term mortality were critical preoperative state (hazard ratio: 3.5; P<0.0001) and coronary artery occlusion during PCI (hazard ratio: 2.6; P=0.002). The 5‐ and 10‐year freedom from major adverse cardiac and cerebrovascular events was 59.7±4.0% and 41.9±5.0%. Conclusions Iatrogenic injuries after PCI or coronary angiography requiring surgical correction are associated with a high operative and long‐term mortality. Patients developing acute coronary artery occlusion have a more guarded long‐term prognosis. Hospital survivors, however, have a superior long‐term survival. See Editorial by Affronti and Ruel
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Affiliation(s)
| | | | - Sergey Leontyev
- 1 University department of Cardiac Surgery Leipzig Heart Center Germany
| | - Sven Lehmann
- 1 University department of Cardiac Surgery Leipzig Heart Center Germany
| | - Michael A Borger
- 1 University department of Cardiac Surgery Leipzig Heart Center Germany
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Guttmann OP, Jones DA, Gulati A, Kotecha T, Fayed H, Patel D, Crake T, Ozkor M, Wragg A, Smith EJ, Weerackody R, Knight CJ, Mathur A, O'Mahony C. Prevalence and outcomes of coronary artery perforation during percutaneous coronary intervention. EUROINTERVENTION 2017; 13:e595-e601. [PMID: 28414656 DOI: 10.4244/eij-d-16-01038] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS We aimed to examine the prevalence, clinical outcomes and procedural characteristics of percutaneous coronary intervention (PCI) complicated by coronary artery perforation (CAP) in a contemporary patient population. METHODS AND RESULTS Procedural records of 39,115 patients undergoing PCI between 2005 and 2016 were reviewed. CAP affected 149 cases (0.37%). The prevalence of CAP increased from 0.31% in 2005 to 0.45% in 2016 (p=0.03), reflecting an increase in more complex PCI (from 14% in 2005 to 21% in 2016; p<0.0001). CAP was associated with increased all-cause mortality (23.1% vs. 9.4% in those without perforation; p=0.0054) and was an independent predictor of mortality (HR 2.55; 95% CI: 1.34-4.78). In-patient mortality was 4% (6/149). In 43 of 149 (28.9%) cases, a significant pericardial effusion ensued and mortality rates were higher in this subgroup. Thirty-one patients had covered stents (CS) inserted and five did not survive to discharge. Of the 26 patients with a CS who survived to hospital discharge, six (23.1%) had definite stent thrombosis, and two (7.7%) had possible/probable stent thrombosis. CONCLUSIONS CAP remains uncommon but the prevalence is increasing. CAP is associated with significant short- and long-term mortality, particularly when there is haemodynamic compromise necessitating pericardiocentesis. Covered stents are a valuable tool but they are associated with a high risk of stent thrombosis.
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Affiliation(s)
- Oliver P Guttmann
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
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Almdahl SM, Veel T, Halvorsen P, Rynning SE. Immediate rescue operations after failed diagnostic or therapeutic cardiac catheterization procedures. Interact Cardiovasc Thorac Surg 2013; 17:314-7. [PMID: 23667069 DOI: 10.1093/icvts/ivt214] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Although rare, life-threatening complications requiring emergency cardiac surgery do occur after diagnostic and therapeutic cardiac catheterization procedures. The operative mortality has been persistently reported to remain high. The purpose of this observational study was to evaluate and report the outcomes, with particular emphasis on early mortality, of these risky operations that were performed in a single highly specialized cardiac centre. METHODS Between June 1997 and August 2007, 100 consecutive patients, 13 after diagnostic complicated cardiac catheterization (0.038% of 34,193 angiographies) and 87 after crashed percutaneous coronary intervention (PCI; 0.56% of 15,544 PCIs), received emergency operations at the Feiring Heart Center. In the same period, 10,192 other patients underwent open cardiac surgery. Early outcome data were analysed and compared between the cohorts. Follow-up was 100% complete. RESULTS The preoperative status of the 100 patients was that 4 had ongoing external cardiac massage, 24 were in cardiogenic shock, 32 had frank enduring ST-segment infarction but without shock and 40 had threatened acute myocardial infarction. There was 1% (1 patient) 30-day mortality in the study group, which is equal (0.9%, P=0.60) to that of all other operations. Postoperative myocardial infarction and prolonged ventilator use were significantly higher in the crash group, whereas the rate of stroke, renal failure, reopening for bleeding and mediastinitis were similar between the groups. CONCLUSIONS With rapid transfer to an operation room, minimizing the time of warm myocardial ischaemia, and by performing complete coronary revascularization, it is possible to obtain equally low operative mortality in patients with life-threatening cardiac catheterization-associated complications, as is the case with open cardiac operations in general.
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Affiliation(s)
- Sven M Almdahl
- Department of Cardiac Surgery, Feiring Heart Center, Feiring, Norway.
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Shahian DM, Meyer GS, Yeh RW, Fifer MA, Torchiana DF. Percutaneous coronary interventions without on-site cardiac surgical backup. N Engl J Med 2012; 366:1814-23. [PMID: 22571203 DOI: 10.1056/nejmra1109616] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- David M Shahian
- Center for Quality and Safety and Department of Surgery, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA.
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Chon SH, Kim YH, Kim H, Chung WS, Kang JH, Shin KW. Postinfarct ventricular septal defect after coronary covered stent implantation. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2012; 45:45-8. [PMID: 22363908 PMCID: PMC3283784 DOI: 10.5090/kjtcs.2012.45.1.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 09/05/2011] [Accepted: 10/15/2011] [Indexed: 11/29/2022]
Abstract
We report a case of a postinfarction ventricular septal defect caused by an acute recurrent occlusion after the implantation of a covered stent, which was performed as a rescue procedure for the ruptured left anterior descending artery during a percutaneous coronary intervention. Although the emergent implantation of a covered stent for the ruptured coronary arteries such as the left main coronary artery or the origins of the left anterior descending artery can be performed during a percutaneous coronary intervention, and a coronary bypass surgery should be considered in order to decrease the risk of complete occlusion, thus providing a superior long term patency.
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Affiliation(s)
- Soon Ho Chon
- Department of Thoracic and Cardiovascular Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Korea
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Maganti M, Brister SJ, Yau TM, Collins S, Badiwala M, Rao V. Changing trends in emergency coronary bypass surgery. J Thorac Cardiovasc Surg 2011; 142:816-22. [DOI: 10.1016/j.jtcvs.2011.01.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Revised: 12/09/2010] [Accepted: 01/10/2011] [Indexed: 10/18/2022]
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Al-Lamee R, Ielasi A, Latib A, Godino C, Ferraro M, Mussardo M, Arioli F, Carlino M, Montorfano M, Chieffo A, Colombo A. Incidence, predictors, management, immediate and long-term outcomes following grade III coronary perforation. JACC Cardiovasc Interv 2011; 4:87-95. [PMID: 21251634 DOI: 10.1016/j.jcin.2010.08.026] [Citation(s) in RCA: 146] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 07/26/2010] [Accepted: 08/06/2010] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the incidence, predictors, management, and clinical outcomes in patients with grade III coronary perforation during percutaneous coronary intervention. BACKGROUND Grade III coronary perforation is a rare but recognized complication associated with high morbidity and mortality. METHODS From 24,465 patients undergoing percutaneous coronary intervention from May 1993 to December 2009, 56 patients had grade III coronary perforation. RESULTS Most lesions were complex: 44.6% type B2, 51.8% type C, and 28.6% chronic total occlusions, and within a small vessel (≤ 2.5 mm) in 32.1%. Glycoprotein IIb/IIIa inhibitors were administered in 17.9% of patients. The device causing perforation was intracoronary balloon in 50%: 53.6% compliant, 46.4% noncompliant; intracoronary guidewire in 17.9%; rotablation in 3.6%; and directional atherectomy in 3.6%. Following perforation, immediate treatment and success rates, respectively, were prolonged balloon inflation 58.9%, 54.5%; covered stent implantation 46.4%, 84.6%; coronary artery bypass graft surgery (CABG) and surgical repair 16.0%, 44.4%; and coil embolization 1.8%, 100%. Multiple methods were required in 39.3%. During the procedure (n = 56), 19.6% required cardiopulmonary resuscitation and 3.6% died. In-hospital (n = 54), 3.7% required CABG, 14.8% died. The combined procedural and in-hospital myocardial infarction rate was 42.9%, and major adverse cardiac event rate was 55.4%. At clinical follow-up (n = 46) (median: 38.1 months, range 7.6 to 122.8), 4.3% had a myocardial infarction, 4.3% required CABG, and 15.2% died. The target lesion revascularization rate was 13%, with target vessel revascularization in 19.6%, and major adverse cardiac events in 41.3%. CONCLUSIONS Grade III coronary perforation is associated with complex lesions and high acute and long-term major adverse cardiac event rates.
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Affiliation(s)
- Rasha Al-Lamee
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
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Melberg T, Nilsen DWT, Larsen AI, Barvik S, Bonarjee V, Kuiper KKJ, Nordrehaug JE. Nonemergent coronary angioplasty without on-site surgical backup: a randomized study evaluating outcomes in low-risk patients. Am Heart J 2006; 152:888-95. [PMID: 17070152 DOI: 10.1016/j.ahj.2006.06.026] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2005] [Accepted: 06/16/2006] [Indexed: 11/21/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) in nonemergent patients with coronary artery disease in hospitals without on-site cardiac surgery backup is still controversial. To prospectively evaluate a set of low procedural risk criteria for PCI, patients with stable or unstable angina were randomized to treatment in either a community hospital, which had all supportive services except for on-site cardiac surgery, or a regional surgical hospital 213 km away. METHODS AND RESULTS During a 4-year period, 609 (57%) of 1064 consecutive patients with stable or unstable angina who underwent coronary angiography at a teaching community hospital in Norway fulfilled the predefined low-risk criteria for PCI. The patients were randomized to treatment at either the community hospital (n = 305) or at the regional hospital (n = 304). The angiographic success rate (96% at both hospitals) and number of major periprocedural complications (overall 0.3%) were equal at the 2 hospitals. In particular, there were no deaths or need for urgent transfer to cardiac surgery. At 6 months of clinical follow-up, there was a significant higher major adverse cardiac event rate rate at the community hospital, compared with the regional hospital (6.9% vs 2.3%, respectively, P = .03) because of more repeat target vessel revascularizations. Improvement in angina functional class and exercise capacity was similar in both groups. The excluded high-risk PCI patients had higher 6-month major adverse cardiac event compared with all low-risk patients (8.4% vs 4.3%, respectively, P = .01). CONCLUSION Selected nonemergent patients can, based on angiography, safely undergo PCI at hospitals without cardiac surgery backup. The angiographic selection criteria identified high-risk patients, which had worsened outcome at 6 months of follow-up.
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Affiliation(s)
- Tor Melberg
- Division of Cardiology, Stavanger University Hospital, Stavanger, Norway
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Haan CK, O'Brien S, Edwards FH, Peterson ED, Ferguson TB. Trends in Emergency Coronary Artery Bypass Grafting After Percutaneous Coronary Intervention, 1994–2003. Ann Thorac Surg 2006; 81:1658-65. [PMID: 16631652 DOI: 10.1016/j.athoracsur.2005.09.079] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2005] [Revised: 09/28/2005] [Accepted: 09/30/2005] [Indexed: 11/29/2022]
Abstract
BACKGROUND In the last decade, percutaneous coronary intervention (PCI) has undergone profound changes in techniques used to achieve revascularization and in patient selection. We examine trends in emergency surgical revascularization after PCI. METHODS Using The Society of Thoracic Surgeons National Cardiac Surgery Database, we examined patients undergoing coronary artery bypass grafting within 6 hours of PCI from 1994 to 2003. Stratifying into groups of patients who had and had not suffered myocardial infarction within 24 hours of PCI followed by coronary artery bypass grafting (CABG), we tracked trends in characteristics, predicted risk, and clinical outcomes. RESULTS The proportion of isolated CABG procedures done emergently after PCI decreased over 1994 to 1999 from 3,357 of 115,679 (2.9%) to 1,227 of 155,831 (0.8%), remaining stable through 2003. Those suffering myocardial infarction within 24 hours made up a constant proportion of isolated CABG as emergency after PCI (3,352 of 1,042,864; 0.3%) since 1997. Over the decade, the preoperative risk profile worsened, including more elderly patients and more with cerebrovascular disease and congestive heart failure. Operative mortality among these patients has risen with time (from 8.0% to 9.3%; p < 0.0001 for trend), particularly in the setting of acute myocardial infarction (from 14.1% to 16.6%; p < 0.0001 for trend). Similarly, postoperative complications have increased over time, most notably seen in the need for reoperation (10.62% to 24.56%), prolonged postoperative ventilation (25.65% to 54.58%), and renal failure (10.22% to 18.55%). CONCLUSIONS In 2005, there remains a low but real need for emergent CABG after PCI, in which operative outcomes are less than ideal, especially in the postinfarction patient, representing an area for cross-specialty collaboration.
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Affiliation(s)
- Constance K Haan
- Division of Cardiothoracic Surgery, University of Florida/Jacksonville, Jacksonville, Florida, USA.
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Dehmer GJ, Gantt DS. Coronary intervention at hospitals without on-site cardiac surgery: are we pushing the envelope too far?**Editorials published in the Journal of the American College of Cardiologyreflect the views of the authors and do not necessarily represent the views of JACCor the American College of Cardiology. J Am Coll Cardiol 2004; 43:343-5. [PMID: 15013112 DOI: 10.1016/j.jacc.2003.11.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Barakate MS, Bannon PG, Hughes CF, Horton MD, Callaway A, Hurst T. Emergency surgery after unsuccessful coronary angioplasty: a review of 15 years' experience. Ann Thorac Surg 2003; 75:1400-5. [PMID: 12735553 DOI: 10.1016/s0003-4975(02)05026-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Emergency coronary artery bypass grafting (CABG) is occasionally necessary for failed percutaneous transluminal coronary angioplasty (PTCA). The aim of this study was to assess the outcome of patients receiving emergency CABG after unsuccessful PTCA over a 15-year study period. METHODS From January 1982 through December 1996, 74 patients underwent emergency CABG after unsuccessful PTCA (crash group). This group was compared with a matched group of 74 patients having primary elective CABG (control group). RESULTS All 74 crash group patients were to have PTCA of one coronary system. After PTCA failure, 58 patients (78.3%) developed electrocardiographic changes of evolving acute myocardial infarction (AMI). The overall rate of AMI was 8.1% for the crash group and 2.7% for the control group. Two patients in the crash group died, with no deaths in the control group. There was no significant difference between mean in-hospital length of stay. CONCLUSIONS With prompt, aggressive, and complete myocardial revascularization, patients who required emergency CABG after PTCA failure had an outcome not significantly different from that of patients having elective CABG.
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Affiliation(s)
- Michael S Barakate
- Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia.
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Reinecke H, Trey T, Matzkies F, Fobker M, Breithardt G, Schaefer RM. Grade of chronic renal failure, and acute and long-term outcome after percutaneous coronary interventions. Kidney Int 2003; 63:696-701. [PMID: 12631136 DOI: 10.1046/j.1523-1755.2003.00784.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Patients with moderate chronic renal failure have recently been identified to suffer from a markedly higher mortality after percutaneous coronary intervention (PCI). We focused on the outcome of PCI patients with just mildly elevated creatinine levels of 1.1 to 1.5 mg/dL. METHODS Data of all PCI patients of the years 1998 to 1999 were analyzed. Follow-up was performed by a questionnaire sent to all patients. RESULTS During this period, PCI was performed in 1049 patients. Long-term follow-up (1184 +/- 10 days) was 99.6% complete. Total mortality increased continuously by each creatinine increment of 0.1 mg/dL above 1.0 mg/dL, with a significant difference at 1.3 mg/dL compared to patients with <or=1.0 mg/dL (12.4 vs. 5.5%, P < 0.05). In a Kaplan-Meier model, patients with a creatinine of 1.3 to 1.4 mg/dL had a significantly lower cumulative survival after three years (87%) than controls (96%, P = 0.0108, log rank test). Higher serum creatinine levels were found to be significantly associated with death in univariate analysis (1.1 +/- 0.4 vs. 1.5 +/- 1.0 mg/dL, P < 0.00001), and in multivariate analysis by stepwise logistic regression (OR 2.122, 95% CI 1.585 to 2.841). CONCLUSIONS In this retrospective cross-sectional study, even patients with slightly elevated serum creatinine levels of 1.3 to 1.4 mg/dL had a significantly reduced long-term outcome after PCI. Thus, even mild chronic renal failure appears to be associated with markedly increased risk after a PCI, with implications to the high number of patients concerned.
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Affiliation(s)
- Holger Reinecke
- Department of Cardiology and Angiology, Medizinische Klinik und Poliklinik C, University Hospital Münster, Münster, Germany.
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Gunning MG, Williams IL, Jewitt DE, Shah AM, Wainwright RJ, Thomas MR. Coronary artery perforation during percutaneous intervention: incidence and outcome. Heart 2002; 88:495-8. [PMID: 12381642 PMCID: PMC1767399 DOI: 10.1136/heart.88.5.495] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To examine the clinical outcome of percutaneous coronary intervention where the procedure was complicated by vessel perforation. SETTING Tertiary referral centre. METHODS The procedural records of 6245 patients undergoing coronary intervention were reviewed. In 52 patients (0.8%) the procedure was complicated by vessel perforation, ranging from wire exit to free flow of contrast into the pericardial space. The majority of lesions treated were complex (37% type B, 59% type C) and 9 of 52 (17%) were chronic occlusions. Ten patients (19%) received abciximab. Four underwent rotational atherectomy (8%). RESULTS In 28 of 52 patients (54%) the perforation was benign and managed conservatively without the development of haemodynamically significant sequelae. In 24 of 52 (46%) a significant pericardial effusion ensued requiring drainage. Of these 24 procedures 6 had involved the treatment of a chronic occlusion (25%). Eight of the 24 patients were referred for emergency bypass surgery (33%), 3 of whom died. Of the remaining 16 not referred for surgery, 3 died. Of the 10 procedures complicated by vessel perforation where abciximab had been administered, 9 (90%) led to pericardial tamponade. Latterly 2 vessel perforations were successfully treated by the deployment of a covered stent. CONCLUSIONS Coronary artery perforation with sequelae during intervention is rare--26 of 6245 (0.4%). This complication was seen in the treatment of chronic occlusions, which are therefore not risk-free procedures. The development of pericardial tamponade carries a high mortality. While prompt surgical intervention may be life saving, expertise in the use of covered stents may provide a valuable rescue option for this serious complication. Caution should be exercised where coronary perforation occurs and abciximab has been used.
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Affiliation(s)
- M G Gunning
- Department of Cardiology, Kings College Hospital, London, UK.
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Abstract
Periodontists are often called upon to provide periodontal therapy for patients with a variety of cardiovascular diseases. Safe and effective periodontal treatment requires a general understanding of the underlying cardiovascular diseases, their medical management, and necessary modifications to dental/periodontal therapy that may be required. In this informational paper more common cardiovascular disorders will be discussed and dental management considerations briefly described. This paper is intended for the use of periodontists and members of the dental profession.
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Albes JM, Gross M, Franke U, Wippermann J, Cohnert TU, Vollandt R, Wahlers T. Revascularization during acute myocardial infarction: risks and benefits revisited. Ann Thorac Surg 2002; 74:102-8. [PMID: 12118738 DOI: 10.1016/s0003-4975(02)03611-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Indication for immediate revascularization during acute myocardial infarction (MI) is debated. Drug-resistant crescendo angina, as well as hemodynamic compromise, however, often requires acute operation. In this study the differential risks of acute coronary artery bypass grafting with and without MI were stratified. METHODS Five hundred eighteen patients undergoing isolated coronary artery bypass grafting were investigated. Thirty-nine patients underwent acute revascularization because of enzyme-proven or electrocardiogram-proven MI accompanied by crescendo angina, hemodynamic compromise, or both. They were compared with 33 emergent, 63 urgent, and 383 elective patients without MI. Preoperative risk factors for early mortality and necessity of continuous venovenous hemofiltration were analyzed by means of logistical regression analysis. Perioperative data were compared. RESULTS Early mortality of the MI cohort was 15.4%, in contrast to 15.2% in emergent, none in urgent, and 2.1% in elective patients. Left internal thoracic artery was used in 87% of MI, 97% of emergent, 94% of urgent, and 97% of elective patients. Intraaortic balloon pump was necessary in 50% of MI patients, 27% of emergent, 6.3% of urgent, and 3.1% of elective cases. Continuous venovenous hemofiltration was performed in 29% of MI patients, 15% of emergent, 4.9% of urgent, and 3.4% of elective patients. Hemodynamic instability significantly increased the odds ratio for early mortality and continuous venovenous hemofiltration. CONCLUSIONS Patients undergoing acute revascularization carried an elevated risk to die early notwithstanding the presence or absence of acute MI. Liberal use of left internal thoracic artery grafts was not detrimental in acute patients whereas liberal use of intraaortic balloon pump was beneficial. In almost 30% of MI patients, continuous venovenous hemofiltration was not necessary, implying a severely impaired perioperative hemodynamic condition. Immediate revascularization in the presence of acute MI is therefore indicated although it may be addressed as a separate high-risk group.
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Affiliation(s)
- Johannes M Albes
- Department of Cardiothoracic and Vascular Surgery, Friedrich-Schiller-University Hospital Jena, Germany.
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