FACTORS INFLUENCING MORTALITY AFTER EMERGENCY CORONARY-ARTERY BYPASS-GRAFTING FOR FAILED PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

Background. Emergency coronary artery bypass grafting after failed per cutaneous transluminal coronary angioplasty is associated with increas ed mortality. Methods. From 1981 through 1995, 117 patients at our ins titution underwent emergency coronary artery bypass grafting after fai led percutaneous transluminal coronary angioplasty, with an in-hospita l mortality rate of 13.6%. Univariate and multivariate analyses were u sed to identify the factors that influenced the risk of death. Results . Univariate analysis revealed that patients who died more often were women and had chronic renal failure, lower ejection fractions, and mor e diffuse coronary artery disease; less often received an internal mam mary artery graft or an antegrade perfusion catheter; required inotrop ic support in the cardiac catheterization laboratory; and experienced myocardial infarction. Multivariate analysis demonstrated that the nee d for inotropic support in the cardiac catheterization laboratory was the best predictor of perioperative death. Conclusions. Patients with a reduced ejection fraction in whom percutaneous transluminal coronary angioplasty fails, antegrade perfusion does not produce a response, a nd myocardial infarction occurs are more likely to die after coronary artery bypass grafting. The risk appears to be highest for patients wh o require inotropic support in the cardiac catheterization laboratory. (C) 1997 by The Society of Thoracic Surgeons.