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European Heart Journal 1989 10(Supplement H):104-111; doi:10.1093/eurheartj/10.suppl_H.104
Copyright © 1989 by the European Society of Cardiology.
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© 1989 The European Society of Cardiology

Acute myocardial ischaemia and cardiogenic shock after percutaneous transluminal coronary angioplasty; risk factors for and results of emergency coronary bypass

J. J. Bredée*,, J. H. Bavinck*, E. Berreklouw*, H. J. Bonnier{dagger}, C. van Doorn*, M. I. El Gamal{dagger}, P. N. Hendel*, Y. A. Mashhour*, H. R. Michels{dagger}, T. H. Relik{dagger}, J. P. Schönberger*, J. Steenbrink*, R. N. van Wandelen* and F. J. Ter Woorst*

Departments of Cardiopulmonary Surgery
* Departments of Cardiology The Netherlands
{dagger} Catharina Hospital, Eindhoven The Netherlands

Address for correspondence: J. J. Brédee, Department of Cardiopulmonary Surgery, Catharina Hospital, P.O. Box 1350, 5502 ZA. Eindhoven, The Netherlands

Between 1 September, 1980 and 1 January, 1989, 4142 patients underwent percutaneous transluminal coronary angioplasty (PTCA). We retrospectively studied the 155 [3·7%; 119 males, mean age 53·4 years, (range 33–78 years) and 36 females, mean age 59·6 years (range 40–74 years) ] who required urgent coronary artery bypass grafting (CABG) (Group I) and a select control group of 155 patients, in whom PTCA was performed without complications (Group II).

Before PTCA, 14 Group I and 42 Group II patients had angina Class II, and 78 Group I and 49 Group II patients had angina class IV (X2-test, P < 0·05). There were 445 complications in the 155 group I patients: 303 (68%) early (during PTCA) and 141 (32%) late (within24 h). Onarrivalin the operating room 126 patients were stable;five were in cardiac arrest and 19 in cardiogenic shock (AS-group; 24 patients). In the AS-group and control group, respectively, angina Class II occurred in 2/24 (8·3%) and 42/155 (27·1%) patients, angina Class IV in 14/24 (58·3%) and49/155 (31·6%) (P <0·05), single-vessel disease in 8/24 (33·3%) and85/155 (54·8%), triple-vessel disease in 7/24 (29·2%) and 23/155 (14·9%) (P<0·05); elective PTCA in 11/24 (45·8%) and92/155 (59·4%) .urgent PTCA in 12/24 (50%) and48/I55 (30·9%) (P<005), PTCA of the left anterior descending artery (LAD) in 18/24 (75%) and 86/166 (51·8%), PTCA of the right coronary artery in 2/24 (8·3%) and 47/166 (28·3%) (P<0·05).

Angina pectoris Class IV, triple-vessel disease, urgent PTCA and PTCA of the LAD were risk factors for development of cardiac arrest/cardiogenic shock after PTCA.

Of the 155 Group I patients, four (2·6%) died. The myocardial infarction rate was 62/155 (40%). Of the 24 AS-group patients, the myocardial infarction rate was 10/24 (41·7%), although the time to revascu-larization was significantly shorter (median 103 min; range 73·185 min) than in the 126 patients who were in good condition preoperatively (median 135min; range 80·235min) (Wilcoxon's rank sum test, P<0001).

Key Words: Acute myocardial ischaemia • cardiogenic shock • PTCA • risk factors • emergency CABG


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