Emergency aorto-coronary bypass grafting following complications of coronary angioplasty

Acute myocardial ischaemia during percutaneous transluminal coronary angioplasty (PTCA) and allied procedures often necessitates emergency coronary artery bypass grafting (CABG). Between July 1987 and December 1993, a total of 1221 patients underwent PTCA for occlusive coronary artery disease. Twentytwo (1.8%) of them required emergency CABG for various complications. The most common complications leading to emergency CABG were intimal dissection and acute occlusion. Sixteen (72.7%) of these 22 patients were haemodynamlcally unstable when received in the operation suite. Seven of them were on percutaneousfemorofemoral cadiopulmonary bypass support, three on external cardiac massage and six supported with inotropes. The remaining six patients were haemodynamically stable. There were eight (36.3%) deaths, all in the haemodynamically unstable subset of patients.