SurgeryUrgent coronary bypass surgery for failed percutaneous coronary intervention in the stent era: Is backup still necessary?☆
Section snippets
Methods
Use of UCABG for a failed interventional procedure was evaluated in a series of 5655 consecutive patients undergoing PCI between August 1, 1992, and December 31, 1997, at the Beth Israel Deaconess Medical Center West Campus by 7 experienced operators, each of whom performed 150 to 300 PCI procedures annually. Four time periods were defined according to availability and use of coronary stents:
August 1, 1992–July 31, 1993: 1090 patients with 1377 lesions treated before the use of any stents
August
Results
Clinical and lesion characteristics of all patients having interventions during the 4 periods are shown in Tables I and II.Empty Cell Time period P value I (8/1/92-7/31/93) (n = 1090) II (8/1/93-3/31/95) (n = 1646) III (4/1/95-12/31/96) (n = 1785) IV (1/1/97-12/31/97) (n = 1134) Median age (y) 60.2 58.9 61.2 60.5 .8 Female 399 (36.6) 593 (36.0) 623 (34.9) 407 (35.9) .9 Unstable angina 803 (73.7) 1136 (69.0) 1265 (70.9) 782 (69.0) .04 Acute MI 36 (3.3) 43 (2.6) 105
Discussion
Our experience demonstrates a significant decrease in use of UCABG over the time period 1992-1997 from 2.2% to 0.6%. This was associated with no apparent consistent change in patient clinical characteristics and with an increase in lesion complexity and seems most likely the result of an increasing frequency of coronary stenting, 72% in the latest time period. A decreased incidence of UCABG has been reported from other institutions with availability of bail-out2, 4 and more routine stenting.3
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Reprint requests: Samuel J. Shubrooks, Jr, MD, FACC, Beth Israel Deaconess Medical Center, 110 Francis St, Boston, MA 02215. E-mail: [email protected]