Emergency coronary artery bypass surgery following coronary angioplasty and stenting: Results of a French multicenter registry

This study investigates the influence of coronary stenting on the risk of e mergency bypass surgery performed within 24 hr of percutaneous tranluminal coronary angioplasty (PTCA) with particular concern for incidence and indic ation. Since 1995, coronary stenting has been increasingly performed in Fra nce during angioplasty procedures, altering significantly the role of emerg ency bypass surgery. The outcome of elective stenting and widespread use of coronary stenting and its influence on emergency surgery have not been eva luated so far. Through a retrospective (1995) and prospective (1996) regist ry, we analyzed the incidence, indication and results of emergency bypass s urgery performed within 24 hr of PTCA in 68 and 57 centers, respectively, a ccounting for nearly half of all angioplasty procedures in France. Data wer e collected through questionnaires consisting of separate forms for every c ase report that were sent to every center. Over the two years, 26,885 and 2 7,497 procedures were investigated with a stenting rate of 46% and 64%, res pectively. The observed need for emergency surgery was constantly low throu ghout this period (0.38% and 0.32%, respectively). Indications for surgery included complications directly due to stent in 37% of cases in the 2-year period. Outcome remained poor, with in-hospital mortality in 10% and 17% an d myocardial infarction in 27% and 25% of cases, respectively. A comparison of the results in centers with and without surgical facilities showed no d ifferences in outcome, despite a longer time to surgery (359 min +/- 406 mi n vs. 170 min +/- 205 min, P = 0.0001) and a lower incidence of emergency s urgery (0.25% vs. 0.44%, P = 0.0001) in centers without on-site surgery bac kup. The French multicenter registry reveals an increase in the use of sten ts together with a dramatic decrease in the incidence of emergency bypass s urgery (below 0.5%) following PTCA. There has been a significant evolution in the indication, and stent implantation now accounts for a third of the i ndications for emergency bypass surgery. Cathet. Cardiovasc. Intervent 48:4 41-448, 1999. (C) 1999 Wiley-Liss, Inc.