A national evaluation of emergency cardiac surgery after percutaneous coronary intervention and postsurgical patient outcomes.
Kwok, Chun Shing Sirker, Alex Nolan, Jim Zaman, Azfar Ludman, Peter de Belder, Mark Kinnaird, Tim Mamas, Mamas A
Kwok, Chun Shing
Sirker, Alex
Nolan, Jim
Zaman, Azfar
Ludman, Peter
de Belder, Mark
Kinnaird, Tim
Mamas, Mamas A
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2020-06-07
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There is limited national data regarding emergency cardiac surgery for complications sustained after percutaneous coronary intervention (PCI). This study aimed to examine emergency cardiac surgery after PCI in England and Wales and postsurgical patient outcomes. We analyzed patients in the British Cardiovascular Intervention Society database who underwent PCI between 2007 and 2014 and compared characteristics and outcomes for patients with and without emergency cardiac surgery. A total of 549,303 patients were included in the analysis and 362 (0.07%) underwent emergency cardiac surgery. There was a modest decline in the annual rate of emergency cardiac surgery from 0.09% to 0.06% between 2007 and 2014. Variables associated with emergency cardiac surgery included receipt of circulatory support (Odds ratio (OR) 39.20 95% confidence interval (CI) 27.75 to 55.36), aortic dissection (OR 28.39 95%CI 14.59 to 55.26), coronary dissection (OR 18.50 95%CI 13.60 to 25.18), coronary perforation (OR 7.86 95%CI 4.27 to 14.46), cardiac tamponade (OR 6.77 95%CI 3.13 to 14.66), and on-site surgical cover (OR 2.15 95%CI 1.56 to 2.97). After adjustments, patients with emergency cardiac surgery were at increased odds of 30-day mortality (OR 4.41 95%CI 2.94 to 6.62) and in-hospital major adverse cardiac and cerebrovascular events (OR 1.63 95%CI 1.07 to 2.48). On site surgical cover was independently associated with increased odds of mortality (OR 1.26 95%CI 1.20 to 1.33) following emergency cardiac surgery. In conclusion, emergency cardiac surgery after PCI is a rarely required procedure and in England and Wales there appears to be a decline in recent years. Patients who underwent emergency cardiac surgery have higher risk of adverse outcomes and longer length of hospital stay.
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Kwok CS, Sirker A, Nolan J, Zaman A, Ludman P, de Belder M, Kinnaird T, Mamas MA. A National Evaluation of Emergency Cardiac Surgery After Percutaneous Coronary Intervention and Postsurgical Patient Outcomes. Am J Cardiol. 2020 Sep 1;130:24-29. doi: 10.1016/j.amjcard.2020.05.041. Epub 2020 Jun 7
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