Myocardial revascularization after failure of percutaneous transluminal coronary angioplasty.

From 1980 to 1983, 299 procedures for percutaneous transluminal coronary angioplasty were performed in 265 patients. The procedure failed in 88 patients, 72 of whom underwent myocardial revascularization within 1 week following the angioplasty attempt. Operation on an emergency basis was required in 35 patients because of a major complication during or after coronary artery dilatation, whereas the remaining 37 patients underwent elective operation following failure without complication. Coronary occlusion occurred in 23 patients, coronary dissection without occlusion in four, perforation of the coronary artery in one patient, and no visible angiographic changes accounted for the severe myocardial ischemia in the remaining 7 patients. Signs of acute myocardial infarction were present preoperatively in 13 of the 35 patients (37.1%) who underwent emergent operation. Among the factors analyzed, only the absence of collateral circulation and the extent of coronary disease were directly related to the development of complications with percutaneous transluminal coronary angioplasty. There were no early or late deaths in this series. Postoperative complications occurred in seven patients (20%) of the group undergoing emergency operation and in none of the group having elective operation. New postoperative myocardial infarction developed in three patients (8.6%). In six of the 13 patients with preoperative evidence of necrosis, the electrocardiogram returned to normal without other signs of acute infarction after the operation, whereas myocardial infarction was complete in the remaining seven patients. Thus, patients who have complications from percutaneous transluminal coronary angioplasty should undergo immediate operation; for those in whom the procedure fails without complication, surgical treatment can be postponed and performed electively later on if indicated by the clinical incapacity of the patient.