Rate of Urgent Coronary Artery Bypass Grafting in Elective Percutaneous Coronary Intervention (PCI)

Abstract

Background: Latest research shows that about 0.5% of percutaneous coronary intervention (PCI) patients will need urgent coronary artery bypass grafting (CABG) because of coronary accidents. The ACC/AHA guidelines regard on-site cardiac surgery back-up obligatory for PCI centers. It seems the need for urgent CABG in some Iranian PCI centers is less than 0.5%, which may affect decision-making for performing PCI without on-site surgical back-up in the same condition in Iran.

Methods: This retrospective study reviewed all elective PCI documents in two large educational centers with on-site cardiac surgery back-up in Tehran from April 2005 to April 2006. CABG immediately after PCI or until 24 hours after PCI was considered urgent.

Results: There were 1533 PCI patients (71% male) and 1936 PCI vessels in our study. The patients’ mean age was 56 (95% CI 46-66) years. The prevalence of hypertensives, smokers, and diabetics was 42%, 44%, and 24%, respectively. The mean stenotic lesion length was 20.5 mm (95% CI 19.5-21), and the mean lesion diameter was 3.02 mm (95% CI 2.58–3.52). There were 98 (5.8%) unsuccessful PCI procedures. The relative frequency of PCI on different vessels was 1070 (55%) on the left anterior descending artery (LAD), 591(30.5%) on the proximal part of LAD, 286 (14.5%) on left circumflex artery (LCX), 438 (22%) on the right coronary artery (RCA), and 142 (7.2%) on other arteries such as the obtuse marginal (OM) or diagonal arteries. There was only one case of urgent CABG in these patients.

Conclusion: The recent widespread use of coronary stenting, new antiplatelet drugs, and increased skills of operators has ushered in a considerable reduction in urgent CABG after PCI.