Determinants of successful surgical revascularization for failed angioplasty in patients with acute myocardial infarction and cardiogenic shock

Ron Bin Hsu, Robert J. Chen, Shoei Shen Wang, Shu Hsun Chu

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background and Purpose: Previous studies have reported encouraging results with percutaneous transluminal coronary angioplasty (PTCA) in patients with acute myocardial infarction (AMI) and cardiogenic shock (CS). However, PTCA fails in many patients and the mortality rate associated with the procedure is very high. This study sought to assess the determinants of successful coronary artery bypass grafting (CABG) in patients with AMI, CS and failed PTCA. Materials and Methods: From April 1997 to May 2001, 33 patients with a mean age of 62.9 ± 10.5 years underwent CABG for AMI, CS and failed PTCA. PTCA failed or was not attempted because of primary failure in 13 patients, reocclusion in three, no-reflow in one, and multivessel disease in 18. Patients were initially stabilized with inotropic infusion and mechanical circulatory support. Before June 2000, patients underwent conventional CABG, while after June 2000, patients underwent beating heart CABG. Risk factor analysis was performed using retrospective chart review. Results: The overall in-hospital mortality rate was 30.3% - 33.3% in 24 patients who underwent conventional CABG and 22.2% in nine patients who underwent beating heart CABG. Risk factors for death were unstable hemodynamics (p < 0.001), non-right coronary artery as the infarct-related artery (IRA) (p = 0.012), high inotropic dose (p = 0.013), intubation (p = 0.021), cardiopulmonary resuscitation (p = 0.021), and early bypass (p = 0.050). Conclusions: CABG was associated with a high in-hospital mortality rate in patients with AMI, CS and failed PTCA. Patients with unstable hemodynamics and high inotropic dose before surgery had the worst survival rate.

Original languageEnglish
Pages (from-to)815-819
Number of pages5
JournalJournal of the Formosan Medical Association
Volume101
Issue number12
Publication statusPublished - Dec 1 2002
Externally publishedYes

Fingerprint

Cardiogenic Shock
Angioplasty
Myocardial Infarction
Coronary Balloon Angioplasty
Coronary Artery Bypass
Off-Pump Coronary Artery Bypass
Hospital Mortality
Mortality
Hemodynamics
Cardiopulmonary Resuscitation
Intubation
Statistical Factor Analysis
Coronary Vessels
Survival Rate
Arteries

Keywords

  • Acute myocardial infarction
  • Cardiogenic schock
  • Coronary angioplasty
  • Coronary artery bypass
  • Percutaneous transluminal

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Determinants of successful surgical revascularization for failed angioplasty in patients with acute myocardial infarction and cardiogenic shock. / Hsu, Ron Bin; Chen, Robert J.; Wang, Shoei Shen; Chu, Shu Hsun.

In: Journal of the Formosan Medical Association, Vol. 101, No. 12, 01.12.2002, p. 815-819.

Research output: Contribution to journalArticle

@article{ba9fb9513b9744f1803e8ec7c3afbb8f,
title = "Determinants of successful surgical revascularization for failed angioplasty in patients with acute myocardial infarction and cardiogenic shock",
abstract = "Background and Purpose: Previous studies have reported encouraging results with percutaneous transluminal coronary angioplasty (PTCA) in patients with acute myocardial infarction (AMI) and cardiogenic shock (CS). However, PTCA fails in many patients and the mortality rate associated with the procedure is very high. This study sought to assess the determinants of successful coronary artery bypass grafting (CABG) in patients with AMI, CS and failed PTCA. Materials and Methods: From April 1997 to May 2001, 33 patients with a mean age of 62.9 ± 10.5 years underwent CABG for AMI, CS and failed PTCA. PTCA failed or was not attempted because of primary failure in 13 patients, reocclusion in three, no-reflow in one, and multivessel disease in 18. Patients were initially stabilized with inotropic infusion and mechanical circulatory support. Before June 2000, patients underwent conventional CABG, while after June 2000, patients underwent beating heart CABG. Risk factor analysis was performed using retrospective chart review. Results: The overall in-hospital mortality rate was 30.3{\%} - 33.3{\%} in 24 patients who underwent conventional CABG and 22.2{\%} in nine patients who underwent beating heart CABG. Risk factors for death were unstable hemodynamics (p < 0.001), non-right coronary artery as the infarct-related artery (IRA) (p = 0.012), high inotropic dose (p = 0.013), intubation (p = 0.021), cardiopulmonary resuscitation (p = 0.021), and early bypass (p = 0.050). Conclusions: CABG was associated with a high in-hospital mortality rate in patients with AMI, CS and failed PTCA. Patients with unstable hemodynamics and high inotropic dose before surgery had the worst survival rate.",
keywords = "Acute myocardial infarction, Cardiogenic schock, Coronary angioplasty, Coronary artery bypass, Percutaneous transluminal",
author = "Hsu, {Ron Bin} and Chen, {Robert J.} and Wang, {Shoei Shen} and Chu, {Shu Hsun}",
year = "2002",
month = "12",
day = "1",
language = "English",
volume = "101",
pages = "815--819",
journal = "Journal of the Formosan Medical Association",
issn = "0929-6646",
publisher = "Elsevier Science Publishers B.V.",
number = "12",

}

TY - JOUR

T1 - Determinants of successful surgical revascularization for failed angioplasty in patients with acute myocardial infarction and cardiogenic shock

AU - Hsu, Ron Bin

AU - Chen, Robert J.

AU - Wang, Shoei Shen

AU - Chu, Shu Hsun

PY - 2002/12/1

Y1 - 2002/12/1

N2 - Background and Purpose: Previous studies have reported encouraging results with percutaneous transluminal coronary angioplasty (PTCA) in patients with acute myocardial infarction (AMI) and cardiogenic shock (CS). However, PTCA fails in many patients and the mortality rate associated with the procedure is very high. This study sought to assess the determinants of successful coronary artery bypass grafting (CABG) in patients with AMI, CS and failed PTCA. Materials and Methods: From April 1997 to May 2001, 33 patients with a mean age of 62.9 ± 10.5 years underwent CABG for AMI, CS and failed PTCA. PTCA failed or was not attempted because of primary failure in 13 patients, reocclusion in three, no-reflow in one, and multivessel disease in 18. Patients were initially stabilized with inotropic infusion and mechanical circulatory support. Before June 2000, patients underwent conventional CABG, while after June 2000, patients underwent beating heart CABG. Risk factor analysis was performed using retrospective chart review. Results: The overall in-hospital mortality rate was 30.3% - 33.3% in 24 patients who underwent conventional CABG and 22.2% in nine patients who underwent beating heart CABG. Risk factors for death were unstable hemodynamics (p < 0.001), non-right coronary artery as the infarct-related artery (IRA) (p = 0.012), high inotropic dose (p = 0.013), intubation (p = 0.021), cardiopulmonary resuscitation (p = 0.021), and early bypass (p = 0.050). Conclusions: CABG was associated with a high in-hospital mortality rate in patients with AMI, CS and failed PTCA. Patients with unstable hemodynamics and high inotropic dose before surgery had the worst survival rate.

AB - Background and Purpose: Previous studies have reported encouraging results with percutaneous transluminal coronary angioplasty (PTCA) in patients with acute myocardial infarction (AMI) and cardiogenic shock (CS). However, PTCA fails in many patients and the mortality rate associated with the procedure is very high. This study sought to assess the determinants of successful coronary artery bypass grafting (CABG) in patients with AMI, CS and failed PTCA. Materials and Methods: From April 1997 to May 2001, 33 patients with a mean age of 62.9 ± 10.5 years underwent CABG for AMI, CS and failed PTCA. PTCA failed or was not attempted because of primary failure in 13 patients, reocclusion in three, no-reflow in one, and multivessel disease in 18. Patients were initially stabilized with inotropic infusion and mechanical circulatory support. Before June 2000, patients underwent conventional CABG, while after June 2000, patients underwent beating heart CABG. Risk factor analysis was performed using retrospective chart review. Results: The overall in-hospital mortality rate was 30.3% - 33.3% in 24 patients who underwent conventional CABG and 22.2% in nine patients who underwent beating heart CABG. Risk factors for death were unstable hemodynamics (p < 0.001), non-right coronary artery as the infarct-related artery (IRA) (p = 0.012), high inotropic dose (p = 0.013), intubation (p = 0.021), cardiopulmonary resuscitation (p = 0.021), and early bypass (p = 0.050). Conclusions: CABG was associated with a high in-hospital mortality rate in patients with AMI, CS and failed PTCA. Patients with unstable hemodynamics and high inotropic dose before surgery had the worst survival rate.

KW - Acute myocardial infarction

KW - Cardiogenic schock

KW - Coronary angioplasty

KW - Coronary artery bypass

KW - Percutaneous transluminal

UR - http://www.scopus.com/inward/record.url?scp=0036984311&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036984311&partnerID=8YFLogxK

M3 - Article

C2 - 12632813

AN - SCOPUS:0036984311

VL - 101

SP - 815

EP - 819

JO - Journal of the Formosan Medical Association

JF - Journal of the Formosan Medical Association

SN - 0929-6646

IS - 12

ER -