HAVE PTCA FAILURES REQUIRING EMERGENT BYPASS OPERATION CHANGED

From 1980 through 1990, 9,145 patients had balloon angioplasty with fa ilure of the procedure requiring emergent surgical revascularization w ithin 24 hours occurring in 253 patients (2.8%). patients were divided into two cohorts based on the date of the percutaneous transluminal c oronary angioplasty (PTCA): 1980 to 1985 (n = 109) and 1986 to 1990 (n = 144). The incidence of PTCA failure was 3.8% during 1980 to 1985 (1 09/2,903) and decreased to 2.3% (144/6,242) for 1986 to 1990. Comparis on of pre-PTCA patient characteristics between the two periods showed that only a history of a previous PTCA and class III or class IV sympt oms were more common in the recent years (p less than or equal to 0.05 ). In-hospital mortality after emergency operation was 4.6% (5/109) du ring 1980 to 1985 and 7.6% (11/144) from 1985 to 1990 (p = not signifi cant). This trend toward increased mortality appeared to be related to an increased number of patients who underwent operation in a state of severe hemodynamic compromise in the more recent period. The in-hospi tal mortality rate for patients in shock or undergoing cardiopulmonary resuscitation was 28.3% (13/46) compared with 1.4% (3/207) for patien ts with less severe hemodynamic derangement (p < 0.001). Use of the in traaortic balloon pump preoperatively increased from 12.8% to 32.6% (p < 0.01). Late survival was 92% at 2 and 87% at 5 postoperative years. Although the incidence of PTCA failure necessitating emergent surgica l intervention has decreased over time, there has been a trend toward an increased in-hospital mortality rate for those patients that does n ot appear to be related to more severe pre-PTCA characteristics. This trend does correlate with an increased prevalence of severe hemodynami c compromise in patients needing emergent operation and has occurred d espite increased use of intraaortic balloon pump support.