M. R. Adams et al.: Rescue PCI following CABG
285
interventional techniques and minimally invasive cardiac sur-
gery may facilitate protected treatment of left main coronary
artery stenosis or complete revascularization without the need
for cardiopulmonary bypass.31, 32 These changing patterns of
resource utilization should be considered when planning hos-
pital facilities and patient triage.
5. Rasmussen C, Thiis JJ, Clemmensen P, Efsen F, Arendrup HC,
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Block PC, Coady P, Cohen H, Cowley M, Dorros G, Faxon D,
Holmes DR, Jacobs A, Kelsey SF, King SB, Myler R, Slater J,
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Heart, Lung, and Blood Institute Registries. Circulation 2000;102:
2945–2951
Limitations
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The current study is a single-center, retrospective study,
and these results may not be applicable to all centers. The
study was only designed to analyze patients who had failed
PCI or CABG in hospital, and it is possible that some events
may have occurred following discharge from the hospital.
However, the scope of this study was to examine the need for
rescue CABG or PCI during the patient’s index hospital ad-
mission secondary to procedural failure, rather than resteno-
sis or other causes of subsequent failure of the initial revascu-
larization strategy.
9. Schieman G, Cohen BM, Buchbinder M: Standby percutaneous
coronary angioplasty for coronary artery bypass surgery. Cathet
Cardiovasc Diagn 1990;21:159–161
10. Meier B: Surgical standby for percutaneous transluminal coronary
angioplasty. In Textbook of Interventional Cardiology (Ed. Topol
EJ), p. 466. Philadelphia: W. B. Saunders, 1999
Conclusions
11. Gruentzig AR, Senning A, Siegenthaler WE: Nonoperative dilata-
tion of coronary-artery stenosis: Percutaneous transluminal coro-
nary angioplasty. N Engl J Med 1979;301:61–68
12. Seckler JI, Butte A, Harrell L, Palacios I, Jang IK: Acute occlusion
during coronary interventions: The changing pattern in the era of
stents. J Invas Cardiol 1998;10:208–212
13. Holmes DR, Hirshfeld J, Faxon D, Vliestra RE, Jacobs A, King
SBI: ACC expert consensus document on coronary artery stents:
Document of the American College of Cardiology. J Am Coll
Cardiol 1998;32:1471–1482
14. Angeli P: Guidelines for surgical standby for coronary angioplasty:
Should they be changed? J Am Coll Cardiol 1999;33:1266–1268
15. Ladowski JS, Dillon TA, Deschner WP, DeRiso AJ, Peterson AC,
Schatzlein MH: Durability of emergency coronary artery bypass
for complications of failed angioplasty. Cardiovasc Surg 1996;4:
23–27
16. Talley JD, Weintraub WS, Roubin GS, Douglas JS, Anderson HV,
Jones EL, Morris DC, Liberman HA, Craver JM, Guyton RA:
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outcome at 5 years. Circulation 1990;82:1203–1213
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artery as a graft in emergency coronary artery bypass grafting after
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Rescue CABG continues to play an important role in the
management of failed PCI, but the need for rescue CABG has
decreased over the last 7 years, and it may now be equally
common for patients to require rescue PCI following failed
CABG. Furthermore, hybrid procedures may facilitate inno-
vative approaches to challenging clinical problems. Patients
undergoing percutaneous or surgical revascularization benefit
from close cooperation between the cardiac surgeon and the
interventional cardiologist. The advantages of such a relation-
ship and these changing patterns of resource utilization should
be considered when planning hospital facilities and patient
triage. Confirmation of these reported trends and study of the
technical and logistical challenges posed by rescue PCI fol-
lowing failed CABG is necessary.
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